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Immunosupression is supposed as negative factor in peritonitis for perforated diverticulitis. We report on surgical management - resection withprimary anastomosis (PA)± diverting ileostomy or Hartmann's-procedure (HP) - and outcome with respect to immunosuppression.We included from 1/2007-12/2009 only patients operated on Hinchey III-IV diverticulitis, divided into two groups: with immunosuppression (immunosuppressive treatment, terminal renal insufficiency, concomitant malignancy, post organ-transplant) and without. Patients' ASA-classification, Peritonitis-Severity-Score, surgery, morbidity-mortality and hospital-stay were studied.Fifty patients [mean age 63.4] - 41.1% female - were included. Nineteen fulfilled immunosuppression criteria (group 1). In group 1, PA without ileostomy (10.5%), HP (47.4%) and PA with ileostomy (42.1%) were performed. In group 2, PA without ileostomy (55.2%), HP (34.5%) and PA with ileostomy (9.7%) were performed. Group 1 was 100% classified as ASA III-IV, group 2 just 51.9%. Morbidity-mortality was 73.7%-21.1% in group 1 vs 71.0%-9.7% in group 2. Re-intervention rate was 5.3% vs 6.5%. Hospital stay differed between group 1 (21.92 days) versus group 2 (17.35 days). HP was performed in PSS > 11.There is no difference in morbidity-mortality for Hinchey III-IV diverticulitis with or without immunosuppression. In immunosuppressed patients a PA withprotective ileostomy is a safe option. HP is reserved for patients with PSS > 11.