Diverticulitis occurs when small pouches called diverticula that bulge out from weak spots on the lining of the intestines become inflamed, causing pain, fever, nausea and changes in bowel patterns. Some patients with severe cases of diverticulitis require a surgical procedure called colon resection to remove the diverticula. Other patients might need emergency surgery to treat complications of diverticulitis such as a perforation or peritonitis.
Treatments
According to the Merck Manuals, 80 percent of patients with diverticulitis do not require surgery. Mild cases can be treated successfully at home with bed rest, a liquid diet and antibiotics. As the symptoms subside the patient can progress to a high-fiber diet to reduce the risk of recurrence. More severe cases require hospitalization, with bed rest, steroid treatment and intravenous antibiotics.
Indications for Surgery
Doctors might recommend surgery for patients who suffer from frequent and severe attacks of diverticulitis, or those who do not respond to antibiotics and a liquid diet within about 48 hours, according to the Merck Manuals. Patients over the age of 50 are more likely to need surgery. A doctor might recommend surgery for patients with diverticulitis and painful urination because they could have a bladder perforation.
Procedure
Surgeons treat severe cases of diverticulitis using colon resection. In the traditional procedure, the surgeon makes a large incision in the abdomen to access the intestines. He cuts away the section of the intestines that harbors the diverticula. If possible, the surgeon rejoins the cut ends immediately to recreate a functional digestive system. If rejoining is not possible, the surgeon will create a temporary or permanent diversion of the intestines into a colostomy bag to collect waste.
Laparoscopic Surgery
In a laparoscopic approach, the surgeon makes a few small incisions to allow the insertion of a camera and special instruments into the abdomen. Guided by the camera, the surgeon proceeds with the colon resection. Patients with laparoscopic surgery usually have a shorter hospital stay and recover more quickly than those who undergo traditional surgery.
Surgery for Complications
Patients who have large abscesses, perforations, bowel obstructions, serious bleeding or peritonitis as complications of diverticulitis need surgery immediately to prevent their condition from worsening. The primary goal is to stop the immediate problem and clean out the abdomen to prevent ongoing infection. Often it is not safe to immediately rejoin the cut ends of the colon, so a colostomy is performed. After the patient's condition has improved, a second surgery can rejoin the cut ends and allow normal defecation.
