Purpose: To investigate the incidence of surgery in patients admitted with perforated diverticulitis, with either local gas only or distant gas Methodology: A single centre retrospective analysis of clinical management of patients admitted with diverticulitis complicated by perforation with either local or distant gas over a four-year period (July 2020 to June 2024) was reviewed. Patients with perforated diverticulitis and over 18 years were included. Uncomplicated diverticulitis and patients with diverticular abscesses were excluded. Results: 212 patients were admitted with perforated diverticulitis within the four-year period. 148 (69.8%) had local gas and 64 (30%) had distant gas. 18 (12%) of patients with local gas underwent surgical intervention compared to 39 (70%) of those with distant gas. 62 (29%) of patients went to theatre for surgical intervention. Smokers and patients with known vascular disease were higher risk for needing surgery. 37% and 54% of these two groups requiring surgery. All patients with local gas only who underwent surgical intervention had an anterior resection with 12 (67%) of the these getting a defunctioning ileostomy. 23 (59%) patients with distant gas had an anterior resection with 12 (52%) getting a defunctioning ileostomy. 16 (41%) underwent a Hartmann’s procedure. Meaning the overall stoma rate for the distant gas group was 79.5%. Conclusion: Patients with distant gas have a higher chance of needing surgical management in comparison to those with local gas only. Patients with perforated diverticulitis with local gas only were more likely to get a primary anastomosis. Smoking and having prior known vascular disease were risk factors for requiring surgery.