What is Diverticulitis?
Diverticulitis is a condition that causes small pockets (diverticula) formed by protrusion of mucosa in the wall of your large intestine to become inflamed. This disease has been considered to affect older people but currently, studies have revealed that people who are below 50 years have this condition4.
Symptoms of diverticulitis may vary among people since it depends on severity of the inflammation, the place of the affected diverticulum or small pockets in the walls of your colon. Patients with this condition feel pain in their left lower quadrant section of their colon. They experience changes in their bowel movement. There is also nausea and vomiting which can be accompanied by diarrhea. Patients also complain of constipation and bloating.
Other symptoms of diverticulitis include tenderness in the affected places in the abdomen and this is usually confined to one area. Tenderness also occurs in both the right and left lower quadrant. In case this disease is so severe, it may lead to abscess forming in the affected area. Abscess is the accumulation of pus in a tissue and is usually painful.2
Complications of Diverticulitis
Surgery for this condition can be recommended when the affected colon causes complications in your body. Diverticulitis can cause the following severe complications:6
When an infected pouch or diverticulum in your large intestine ruptures into abdominal opening, abscess can form into this opening and be filled with pus.7
This is a condition where peritoneum becomes inflamed. Peritoneum is a tissue that lines the inside walls of the abdomen and coats most of the organs in the abdomen. It can occur when an infection that started in the colon and spreads to the abdomen.
When peritonitis is not treated early, it can spread into the blood and infect it, a condition known as sepsis. It can also spread to other organs in the body such as heart and cause them to stop working which can lead to death.9
Bowel obstruction happens when either your colon or small intestine is partially or totally blocked. This obstruction prevents fluids, food and gas from moving properly through the intestine. This blockage causes pain that disappears and returns. Diverticulitis can cause large intestine to become narrow hence leading to bowel obstruction.
In case you are experiencing severe bleeding from the abdomen that does not stop even after treatment, surgery may be the suitable option to correct this problem.
Infections in your colon especially from an infected abscess can spread and reach the blood and cause an infection called sepsis.
When Can You Have Diverticulitis Surgery?
You can go for diverticulitis surgery if you have the following3:
- Frequent attacks of diverticulitis. Surgery to remove the diseased part of your colon is only recommended when you have at least three severe recurring cases of diverticulitis.
- When you have a weak immune system, you are at risk of repeated diverticulitis attacks.
- You have an unusual cavity (fistula) between your large intestine and nearby organ especially the uterus and bladder.
In general, studies have shown that patients with diverticulitis only few of them need surgery to treat this condition. Surgical intervention for diverticulitis focuses on removing the affected areas of the large intestine and reconnect remaining parts. A number of surgery methods may be needed to cure the problem but this depends on the severity and nature of symptoms of the condition.
The following surgery methods can be used:
It is a procedure done to remove a damaged or diseased section or all parts of the large intestine or rectum. The main aim of bowel resection is to get out the part of the colon which has problems. The following are type of bowel resection procedures:
- Proctocolectomy– This procedure is done to remove the entire colon that is diseased or damaged.
- Subtotal colectomy- It is used to the whole colon but not the rectum.
- Partial colectomy- It is used to remove the section of the large intestine that is damaged or diseased.
Preparation for Surgery
You will be required to follow the following instructions from your doctor before you undergo surgery:
- Stop taking drugs such as ibuprofen, aspirin since they make it harder for your blood to clot properly.
- Stop smoking if you smoke.
- Clean your intestine to remove any bowel before surgery.
- Take water during the day of surgery.2
Bowel resection can be done either by opening your abdomen or through laparoscopy. In both these procedure, you will be put under a general anesthesia to make you comfortable during surgery.
- Laparoscopy is surgical method where your health professional inserts a laparoscope in the lower abdomen via a small cut. The abdomen is puffed up with gas injected through the needle which pushes the abdomen away from the organs to allow the doctor to view it clearly. The health professional examines the organs in the abdomen to see if there are any problems. In case the damaged or diseased section of the colon is identified, your health professional removes it. Since lymph nodes are also there, they will be removed too.
- In open resection, your health professional makes incisions that are large enough in your abdomen. Your health professional views the organs through the incision made to see if there are problems. When a damaged part of the colon is located, it is removed together with the lymph nodes.
In both types of surgery, the following steps are taken by a health professional:
- Your health professional performs a procedure known as anastomosis. This surgical method is done to set up communication between several distant portions of the intestine. This method re-establishes intestinal link after a damaged or diseased part of the intestine was removed.
- In this procedure, your health professional identifies health sections of the colon and stitches them together to repair the damage.
Fig. A completed bowel resection
- Another procedure that can be done is called colostomy9. In this procedure, your health professional cuts an opening through the abdomen skin called stoma. The colon is joined to the exterior part of your abdomen. Stoma will be used to pass stool into the drainage bag outside your body. This procedure can permanent or temporal.
There are several risks associated with both surgery and anesthesia used during surgery. They include:
- You can react to anesthesia.
- You may have trouble breathing
- There is bleeding and infection at the site of surgery.
- You may also experience blood clots.
- Surgery can damage close organs in the body
- Surgery may cause scar tissues to form in your abdomen which can block your intestines.1
- Bowel resection. https://medlineplus.gov/ency/article/002941.htm
- Diverticulitis surgery. http://www.webmd.com/digestive-disorders/tc/diverticulitis-surgery
- Peritonitis. http://www.webmd.com/digestive-disorders/peritonitis-symptoms-causes-treatments#1
- Abscess. http://www.webmd.com/a-to-z-guides/abscess#1
- Bowel obstruction. http://www.webmd.com/digestive-disorders/tc/bowel-obstruction-topic-overview#1
- Colostomy. https://medlineplus.gov/ency/article/002942.htm