The role of non-operative management (NOM) in perforated diverticulitis: a systematic review

Non-operative management (NOM) appears safe and effective for patients with perforated diverticulitis and pericolic extraluminal air, provided there are no clinical signs of generalized peritonitis. In contrast, its role in cases with distant free air is highly uncertain: the pooled success rate is lower, even among hemodynamically stable patients. Based on these findings, early surgical management should be strongly considered for patients with distant free air, while NOM should only be attempted in highly selected cases under strict clinical and radiological monitoring. Conversely, NOM can be confidently recommended for patients with pericolic air who are stable and without diffuse peritonitis.