Diverticular disease is a common disease of the Western world and results in a significant number of hospital admissions. There is a wide variation in the clinical presentation and severity of the symptoms. Recent work calls into question old dogmatic view and reveals new insights into the epidemiology, pathophysiology and clinical course of this disease. The continuously evolving diagnostic and treatment options for diverticulitis as well as pathophysiology and natural history of diverticular disease are discussed in this review. There is still an ongoing debate about classification, stage-dependent therapeutic options and new treatment modalities while optimal surgical management remains controversial. There's a growing body of evidence supporting less invasive approach to almost every stage of the disease. Recently published data indicate that sigmoid diverticulitis does not mandate surgical management after the second episode of uncomplicated disease as previously recommended. Rather, a more individualized approach, taking into account severity of the attacks and their impact on quality of life, should guide the indication for surgery. Routine elective resection based on young age (<50 years) is no longer recommended. The use of laparoscopy for colonic resection has evolved to become the preferred standard for uncomplicated, elective colonic resection. Complicated diverticulitis still mandates surgical treatment in most patients and remains a life-threatening condition in the case of free peritoneal perforation. Traditionally, the treatment of diverticulitis has included antibiotics for all patients. More recent evidence indicates that in uncomplicated diverticulitis, antibiotics may not be as necessary as initially believed. Treatment options for complicated diverticulitis include sigmoidectomy with terminal colostomy (Hartmann procedure) with or without subsequent colostomy reversal or 1-stage colonic resection with primary anastomosis as well as new treatment modalities such as computed tomography-guided percutaneous drainage and laparoscopic lavage.