Comparison of Surgery and Medicine on the Impact of Diverticulitis (COSMID) Trial

Inclusion Criteria: * Adults ≥18 years * At least one episode of diverticulitis confirmed by CT scan and a colonoscopy (completed or scheduled) to rule out or screen for other colon pathology concordant with screening guidelines * Persistent signs, symptoms, or concerns related to diverticulitis after recovery from an episode of left-sided diverticulitis as confirmed with self-reported QoL limitation. Exclusion Criteria: * Unable to consent in English or Spanish * Current diagnosis or previous endoscopic or surgical interventions for fistula, or stricture or current significant bleeding, related to diverticular disease * Last episode of acute diverticulitis currently unresolved (i.e., on antibiotics for diverticulitis; drain in place) * Previous operation for diverticulitis * Right-sided diverticulitis * Immunodeficiency (e.g., absolute neutrophil count \<500/mm3, chronic immunosuppressive drugs like oral corticosteroids, anti-TNF agents, or known AIDS \[i.e., recent CD4 count \<200\] assessed by patient history) * Actively undergoing chemotherapy or radiation for malignancy * Expectant or concurrent hemodialysis, peritoneal dialysis, treatments using indwelling venous catheters, or conditions putting patient at risk for bacterial seeding * Diagnosis of inflammatory bowel disease (i.e., Crohn's, ulcerative colitis) * Taking prescription medication for irritable bowel syndrome * Intolerance or allergy to all medications in the medical management arm * Comorbid or prior surg…