Diverticulitis is the inflammation or infection of small, bulging pouches (diverticula) that can form in the colon. While the presence of these pouches (diverticulosis) is common, especially with age, diverticulitis can cause symptoms like abdominal pain, fever, nausea, and changes in bowel habits. Surgery for diverticulitis is not always required; its necessity depends on the condition’s severity and presence of complications.
Conservative Management Approaches
For many individuals experiencing diverticulitis, particularly those with uncomplicated cases, non-surgical treatments are often effective. Mild episodes can frequently be managed at home, focusing on allowing the inflamed colon to rest and heal. This typically involves dietary modifications, beginning with a clear liquid diet during a flare-up to reduce strain on the digestive system. As symptoms improve, a gradual reintroduction of low-fiber foods is recommended before returning to a regular, high-fiber diet to help prevent future episodes.
Pain management is another important aspect of conservative care, often involving over-the-counter pain relievers. Antibiotics were traditionally standard for acute diverticulitis. However, recent guidelines suggest they may not always be necessary for mild, uncomplicated cases in healthy individuals. They are still frequently prescribed for more severe symptoms, comorbidities, or signs of systemic infection.
When Surgical Intervention Becomes Necessary
While many cases of diverticulitis respond to conservative measures, certain complications or recurrent severe episodes necessitate surgical intervention. Surgery becomes a consideration when inflammation leads to more serious problems within the colon, often involving specific complications.
One such complication is the formation of an abscess, which is a localized collection of pus resulting from infection. Small abscesses, typically less than 2 to 3 centimeters in diameter, may sometimes resolve with antibiotic treatment alone. However, larger abscesses often require percutaneous drainage, a procedure guided by imaging to drain the pus. Surgical removal of the affected colon segment may be necessary if drainage is not feasible or if the abscess does not respond to these less invasive treatments.
A more urgent scenario arises with a perforation, a tear in the colon wall. This allows intestinal contents to leak into the abdominal cavity, leading to a severe infection of the abdominal lining called peritonitis, requiring immediate emergency surgery. Another complication is the development of a fistula, an abnormal passageway between the colon and another organ. Fistulas do not typically heal on their own and require surgical repair.
Bowel obstruction, a blockage of the intestine, can also occur due to chronic inflammation and scarring from diverticulitis. This complication often warrants surgical intervention to remove the obstructed segment. Beyond acute complications, elective surgery may be recommended for individuals experiencing frequent, debilitating episodes of diverticulitis that significantly reduce their quality of life, even without acute complications. While older guidelines sometimes suggested surgery after a specific number of attacks, current practice emphasizes an individualized approach based on symptoms, overall health, and daily life impact.
Surgical Procedures for Diverticulitis
When surgery for diverticulitis becomes necessary, the most common procedure involves removing the diseased portion of the colon, a procedure known as a colectomy. Since diverticula most frequently form in the sigmoid colon, the lowest part of the colon, a sigmoid colectomy is a common type of surgery performed. The specific surgical approach depends on the patient’s condition and complication.
One primary surgical option is bowel resection with primary anastomosis. In this procedure, the inflamed or damaged section of the colon is removed, and the healthy remaining ends of the colon are then surgically reconnected. This allows normal digestive function without an external collection device. This method is preferred when immediate bowel reconnection is safe.
In situations where there is significant inflammation, severe infection, or an emergency, a colostomy might be necessary. With a bowel resection and colostomy, the diseased colon is removed, but instead of reconnecting the ends internally, one healthy end of the colon is brought through an opening created in the abdominal wall, called a stoma. This stoma allows stool to exit into an external bag. Often temporary, a colostomy allows the colon to heal from severe inflammation or infection and can be reversed later to restore internal bowel continuity.
Surgical procedures can be performed using different techniques. Laparoscopic surgery is a minimally invasive approach that involves several small incisions through which a camera and specialized instruments are inserted. This technique often results in less post-operative pain and quicker recovery compared to traditional open surgery, which requires a larger incision. The choice between laparoscopic and open surgery is based on case complexity and patient health.