What to expect after diverticulitis surgery

Diverticulitis: a common colon disease

What are diverticula?

Diverticula are protuberances in the innermost layers of the large intestine. These layers consist of the mucous membrane and submucous membrane. With increased pressure in the intestine, these layers can bulge outwards through a gap in the muscle layer of the intestinal wall and are then only covered by a fine layer of peritoneum. It is therefore sensitive weak points in the colon wall. Diverticula on the large intestine are usually less than 1 cm in size.

The last part of the colon in the left lower abdomen, just before the rectum, is most commonly affected. In principle, diverticula can also occur in the entire rest of the gastrointestinal tract, except in the stomach. The older we get, the higher the risk of developing diverticula. By the age of 80, approximately 60% of all people have diverticula in the colon, most of them without knowing it, as diverticula do not necessarily cause problems.

How dangerous are diverticula?

Over 75% of patients with diverticula never feel anything and have no symptoms. The rest of them will develop an inflammation of the diverticula, known as diverticulitis, at least once in their lifetime. Diverticula, on the other hand, never lead to cancer.

What symptoms does diverticulitis cause?

Inflammation of the colon diverticula causes dull, sometimes wavy, persistent pain in the abdomen, mostly in the left to middle lower abdomen. Occasionally there is a fever. The blood test may show signs of inflammation.
In the case of a rather mild illness, the symptoms of diverticulitis are difficult to distinguish from irritable bowel syndrome. In the case of severe illness with a perforated bowel, however, life-threatening peritonitis occurs. In this case, the abdominal pain is so severe that you can hardly touch your stomach any more.

How is diverticulitis diagnosed?

The questioning of the patient and the physical examination usually point the doctor on the right path. The examinations of blood and urine as well as the ultrasound examination or computed tomography lead to the diagnosis in almost all cases. Computed tomography is the best examination method to determine the severity of the disease.

How is diverticulitis treated?

At uncomplicated, mild diverticulitis Without additional illnesses, treatment can be limited to close observation by the doctor. Otherwise, and this is usually the case, antibiotics are given. The diet, according to the above recommendations, usually does not have to be paused.

At difficult course a patient is to be admitted to a hospital as an inpatient. The antibiotics are then given intravenously to begin with. Occasionally the diet has to be paused for a few days.

A complicated form of diverticulitis is when there is an abscess, fistula, or bleeding. In this case, surgery is recommended in the so-called non-inflammatory interval. Occasionally, a temporary drain must be placed in an abscess.

A absolute emergency situation occurs when diverticulitis leads to free intestinal breakthrough has led into the abdominal cavity with the stool escaping. In such a situation, an emergency operation is necessary.

How do you operate?

The goal of the operation is to remove the diseased segment of the large intestine and sew the ends of the intestine back together. Today, whenever possible, the operation is performed laparoscopically, i.e. with the so-called "keyhole technique".

How high is the risk of relapse?

The Risk of relapse after successful antibiotic treatment (i.e. without surgery) only affects 2 out of 100 patients. Even if diverticulitis recurs a few years after diverticulitis, which in turn could be treated successfully without surgery, we usually no longer operate today.

The Risk of relapse after complicated diverticulitisthat was successfully treated with antibiotics is significantly larger (36% within 5 years). Risk factors are, for example, an inflamed section of the large intestine> 5 cm in length, an abscess covered by the intestine itself, but also a family history with other family members who also suffered from diverticulitis.