Purpose: To assess the failure rate for conservative management of diverticular abscess in a Western Australian tertiary hospital. Methodology: A single centre retrospective analysis of clinical management of patients admitted with diverticulitis complicated by abscess formation over a four-year period (July 2020 to June 2024) was reviewed. Patients with diverticulitis abscess and over 18 years were included. Uncomplicated diverticulitis was excluded. Results: 126 patients had a diverticular abscess, 83 peri-colic alone, 29 pelvic abscess and 14 with peri-colic and pelvic abscesses. Abscess size (106 patients) varied greatly, ranging from 9 – 100mm in largest dimension (mean 48.8mm). 22 (17%) patients underwent drainage, 21 with percutaneous drainage and one patient underwent laparoscopic washout/drainage. 50% of patients were discharged with a drain still in situ. 1 patient was re-admitted for re-accumulation of abscess post drain removal and 1 patient had failure of drainage, requiring surgical intervention. 30 patients (24%) underwent upfront surgical resection with 5 haemodynamically unstable at surgery. 11 patients had Hartmann’s procedure and 18 had an anterior resection. 9/96 (9%) patients failed conservative management with 8/74 (11%) failing antibiotic alone therapy and 1/22 (4.5%) needing operative management post drainage of abscess. Upfront surgical resection was associated with a longer length of stay compared to those conservatively managed successfully (15.9 days vs 4.7 days for antibiotics alone and 10.6 for drainage). Failure of conservative management was associated with a longer length of stay when compared to patients who had upfront surgical resection. (18 days vs 15.9 days) Conclusion: Diverticular abscesses can be managed conservatively in selected patients although failure of conservative management may be associated with a longer hospital stay when compared to upfront operative management.