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Diverticular disease has an increasing incidence with age, being commonest in elderly patients. Our purpose was to study theprogression of diverticular disease after the first episode of diverticulitis and to compare the results of medical and surgical management.A retrospective study including all patients admitted to our hospital with a diagnosis of acute diverticulitis between 1996 and 2009. Hinchey classification was used to determine the severity of the episodes. The data analysis was done using SPSS software.Between 1996 and 2009 there were 300 patients admitted with a diagnosis of acute diverticulitis. The median age of the population was 58 years. The median follow-up time was 2 years. The majority of patients had one episode with thickening of the mesentery and of the colonic wall. The recurrence rate was 30%. In patients undergoing surgery there were more complications after emergency surgery than following elective surgery. At the time of the last medical evaluation there was a benefit in favour of patientspreviously submitted to surgery, who were less symptomatic than the patients treated with medical management.Patients undergoing surgery for acute diverticulitis have fewer subsequent symptoms than those treated conservatively.