Diverticulitis is the inflammation of small, bulging pouches (diverticula) that can form in the lining of the large intestine. While many individuals with these pouches (diverticulosis) experience no issues, diverticulitis occurs when one or more become inflamed or infected. Most cases are managed without surgery, but specific situations require surgical intervention.
Managing Diverticulitis Without Surgery
Most instances of diverticulitis are mild and can be managed with conservative treatments. This approach typically involves a clear liquid diet to reduce irritation and promote healing of the colon. Rest is also recommended to allow the digestive system to recover.
Antibiotics are often prescribed to combat bacterial infections associated with the inflammation. For mild cases, oral antibiotics may be sufficient, while more severe presentations might require hospitalization with intravenous antibiotics and bowel rest. This non-surgical management aims to alleviate symptoms, reduce inflammation, and allow the affected part of the colon to heal naturally, avoiding more invasive procedures.
When Emergency Surgery is Necessary
Emergency surgery for diverticulitis is reserved for acute, life-threatening complications that demand immediate intervention. One such complication is perforation, where a hole forms in the colon wall, allowing infected material to leak into the abdominal cavity. This can lead to peritonitis, a widespread and potentially fatal infection of the abdominal lining, necessitating urgent surgical repair and cleaning to prevent sepsis.
Large abscesses, especially those unresponsive to drainage or that worsen, also indicate emergency surgery. Bowel obstruction, a blockage preventing movement through the intestines, requires immediate surgical attention. Fistulas, abnormal connections between the colon and another organ (e.g., bladder, vagina), can lead to serious infections and often require emergency repair. Severe, uncontrollable diverticular bleeding that cannot be stopped by less invasive methods also necessitates immediate surgical intervention.
Considering Elective Surgery
Elective surgery for diverticulitis is a planned procedure, typically performed after an acute episode has subsided, to prevent future attacks and complications. Recurrent episodes of acute diverticulitis, particularly after two or more severe attacks, are a common indication. The impact on a patient’s quality of life remains a significant factor.
Persistent symptoms despite conservative treatment, such as ongoing pain, can also lead to a discussion about elective surgery. Complicated diverticulitis that does not fully resolve, including chronic fistulas or strictures causing narrowing of the bowel, are clear indications for planned surgical intervention. For immunocompromised patients (e.g., due to chemotherapy or organ transplantation), elective surgery may be considered earlier due to their increased risk of severe complications. The goal of elective surgery is to remove the diseased colon segment, reducing future inflammatory episodes and improving quality of life.
Common Surgical Procedures
When surgery is needed for diverticulitis, the primary procedure is a bowel resection, also known as a colectomy. The surgeon removes the diseased portion of the colon, most commonly the sigmoid colon. After removal, the healthy ends of the colon can often be reconnected directly, a procedure called primary anastomosis.
In emergency cases with significant infection or inflammation, immediate reconnection may not be safe. A temporary or permanent colostomy may then be created. This involves bringing a portion of the intestine through an opening in the abdominal wall (stoma) to allow stool to exit into an external bag. Surgical approaches vary. Laparoscopic (minimally invasive) surgery, using small incisions, is often preferred for elective procedures due to less pain and quicker recovery. Open surgery, with a larger incision, may be necessary for complicated or emergency cases.