Diverticulitis is one of the most common diseases faced by surgeons in the Western world. Not only is it increasing in incidence, but it is also becoming more prevalent in younger age groups. Surgeons sometimes face acutely ill patients who have developed feculent peritonitis. Historically, the procedure of choice to treat feculent peritonitis has been a Hartmann’s resection. The ostomy created during this procedure can be difficult to manage for some patients and is associated with a variety of complications. These include leaks, skin irritation, high output causing dehydration and electrolyte derangements, prolapse, and parastomal hernias. More recently, increasing evidence suggests other options are safe when used in select patients by a surgeon with the appropriate training. This chapter aims to discuss the presentation of acutely ill patients with feculent peritonitis, review the current standards of care, and discuss emerging treatment options.