Diverticulitis involves the inflammation or infection of small, bulging pouches called diverticula that form in the large intestine. This condition differs from diverticulosis, which is the presence of these pouches without inflammation or symptoms. While many cases of diverticulitis can be managed without surgery, certain situations and complications may necessitate surgical intervention.
Managing Diverticulitis Without Surgery
For uncomplicated diverticulitis, non-surgical approaches are the initial treatment. This involves resting the colon with a temporary clear liquid diet. As symptoms improve, a gradual reintroduction of low-fiber solid foods is recommended, progressing to a high-fiber diet.
Antibiotics may be prescribed if an infection is present, though recent guidelines suggest they might not always be necessary for mild cases. Rest and pain management are also important. These medical strategies are often successful for mild diverticulitis.
When Surgical Intervention Becomes Necessary
While many diverticulitis episodes resolve with conservative care, surgery is considered in severe scenarios. Acute complications often necessitate immediate surgical intervention.
Acute Complications
Perforation: A hole in the colon wall that can lead to peritonitis, a severe inflammation of the abdominal lining requiring emergency surgery.
Large abscesses: Collections of pus that do not respond to antibiotics or drainage.
Fistula: An abnormal connection between the colon and another organ, such as the bladder or skin, causing persistent symptoms.
Bowel obstruction: A blockage preventing waste passage through the colon due to severe inflammation or scarring from prior episodes.
Severe bleeding: Uncontrolled bleeding from a diverticulum that does not stop on its own or with other interventions.
Elective surgery may be considered for chronic or recurrent issues. Individuals who experience multiple severe episodes of diverticulitis that significantly impair their quality of life may be candidates for surgery, especially if previous episodes involved complications. Immunocompromised patients are at a higher risk for severe complications and might benefit from earlier surgical intervention even after an uncomplicated episode. If imaging or colonoscopy cannot definitively distinguish diverticulitis from colon cancer, surgery may be performed to obtain a definitive diagnosis and provide treatment. The decision for surgery considers the patient’s overall health, symptom severity, and specific complications.
Types of Diverticulitis Surgery
The most common surgical procedure for diverticulitis is a bowel resection, also known as a colectomy, which involves removing the diseased section of the colon. Often, the remaining healthy ends of the colon can be reconnected in a procedure called primary anastomosis, allowing for normal bowel function. However, if the inflammation is too severe or the patient’s condition is unstable, a temporary colostomy may be necessary. This involves creating an opening in the abdomen to divert waste into an external bag, giving the colon time to heal before a second surgery to reconnect the bowel.
Surgeries can be performed using laparoscopic or open approaches. Laparoscopic surgery is a minimally invasive technique that uses small incisions, often resulting in less pain and a faster recovery. Open surgery involves a larger incision and may be necessary for more complex or emergency cases.
Life After Diverticulitis Surgery
Recovery following diverticulitis surgery typically involves a hospital stay of a few days to a week, during which pain management is provided and the surgical site is monitored. Patients are gradually transitioned from a liquid diet to soft foods, then to a regular diet as their colon heals. Most individuals can return to normal activities within a few weeks, though avoiding heavy lifting for several weeks is usually advised.
Maintaining a healthy lifestyle, including a high-fiber diet, is recommended after recovery to promote bowel health and potentially reduce the risk of new diverticula forming. While surgery removes the affected segment of the colon, new diverticula can still develop in other parts of the intestine. The risk of recurrence after sigmoid colectomy is low. Regular follow-up appointments with a healthcare provider are important to monitor long-term digestive health.