With perforation during acute diverticulitis, with or without abscess, the highest mortality occurs in patients in whom a transverse colostomy with drainage alone is done. This is no longer to be considered an acceptable method of management. The advantage of removal of the diseased intestine is paramount. Anastomosis under unfavorable conditions is avoided. The results in this group of severe, acutely ill patients with associated multiple systemic disease encouraged wider application of the Hartmann operation for the complex problems of inflammation of the diverticulum.