Diverticulitis Treatment

Diverticulitis
Diverticulitis is a common problem of the colon or large intestine. It begins as a condition known as diverticulosis. The term diverticulosis describes small blebs, or out-pouchings that occur on the wall of the colon, most commonly in the sigmoid colon. Often times these blebs or out-pouchings represent weak spots that are entirely asymptomatic. However, over time, diverticulosis can develop into a more serious condition in which the out-pouchings lead to either bleeding or micro-perforation and pain with inflammation.

Diverticulosis and diverticulitis are common conditions in the western hemisphere and in North America specifically. They are thought to be, at least in part, due to a low fiber diet and increased internal pressures within the sigmoid portion of the colon. The blebs develop just like a small bleb would on an inner tube of a tire, and just like that same tire inner tube, the bleb can burst. When that happens, acute diverticulitis is the result.

Acute diverticulitis is generally treated with antibiotics and resting of the digestive system for a period of time. In mild cases, a person with diverticulitis may feel some discomfort and perhaps a mild fever. These episodes might be treatable on an outpatient basis with oral antibiotics. However, more severe cases result in fevers, chills,  severe abdominal pain, and vomiting.

Diverticular

Diverticula Sigmoid Colon

Diverticulitis

In fact, they can be life threatening due to peritonitis and sepsis.

The diagnosis is generally made by clinical examination by a physician, and most commonly by CT scanning of the abdomen and pelvis. The inflammation is present in the sigmoid colon region, and the diagnosis is usually fairly clear cut on CT scan. The doctors can make a determination if this requires in-patient treatment or even surgery.

Surgery is required when a person has had two or more episodes of diverticulitis that have been treated with antibiotics. The best approach in those cases is a minimally invasive, or laparoscopic removal (resection) of the affected area, which is almost always the sigmoid colon. A primary reconnection or re-anastomosis is possible in a very high percentage of cases, and a colostomy is nearly always avoidable.

The best possible solution occurs when the surgeon can perform the surgery on a scheduled basis, in-between active episodes. This allows for a laparoscopic approach in the hands of a trained, minimally invasive specialist in colorectal surgery, like Dr. Sasse. The procedure is usually performed in about an hour under general anesthesia and requires a three night hospital stay. Recovery time is generally in the neighborhood of three weeks before people return to office work.

Laparoscopic sigmoid colectomy, sometimes also called low anterior resection, is highly successful at eradicating diverticulitis and preventing the severe complications from diverticulitis.

Complications of Diverticulitis:

If left untreated, diverticulitis can cause several severe problems that can require emergency surgery, and in some cases can require a colostomy. Diverticulitis can perforate and form an abscess. This can require surgical drainage, or drainage in a radiology suite in a procedure known under the category of interventional radiology. Diverticulitis can also have a free perforation that results in severe peritonitis and requires emergency surgery and colostomy. Over time, milder, but repeated attacks of diverticulitis can form a tight narrowing of the colon (“colonic stricture”) that produces pain and a blockage, also requiring surgery. At times diverticulosis can result in severe hemorrhage and anemia.

Altogether, these problems or advanced conditions associated with diverticular disease are prevented with minimally invasive, surgical removal of the affected portion of the colon. When this condition is in its earlier stages, the surgical intervention prevents progression, avoids major open surgery, eliminates long recovery periods, and avoids a colostomy. Surgical decision making and aspects of care and treatment of diverticular disease are best provided by specialty surgeons who have completed fellowship training in colon and rectal surgery, surgeons who are considered fellows of the American Society of Colon and Rectal Surgeons, such as Dr. Sasse.

When to call? If you have had recurrent episodes of abdominal pain, especially left lower quadrant abdominal pain, you may have experienced episodes of diverticulitis. If these episodes were treated with antibiotics to resolve them, then it is likely that you may benefit from a diagnostic CT scan or further evaluation. Today, a minimally invasive colorectal procedure can resolve diverticulitis and prevent the progression to severe diverticulitis, and prevent colonic rupture.