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Diverticulosis and Surgical Treatment

  

Diverticula are small pouches that bulge outward through the colon, or large intestine. If you have these pouches, you have diverticulosis. This condition becomes more common as people age. About half of all people over age 60 have it. Doctors believe the main cause is a low-fiber diet. 

Most people with diverticulosis don't have symptoms. Sometimes it causes mild cramps, bloating or constipation. A high-fiber diet and mild pain reliever will often relieve symptoms. 

If the pouches become inflamed or infected, you have diverticulitis. The most common symptom is abdominal pain, usually on the left side. If the diverticula are infected, you may also have 

• fever 

• nausea 

• vomiting 

• chills 

• cramping 

• and constipation. 

In serious cases, diverticulitis can lead to bleeding tears, or blockages. Treatment focuses on clearing up the infection with antibiotics, resting the colon and preventing future problems. A serious case may require surgery. 

INTRODUCTION

 

Diverticulosis is a common condition that could potentially cause life-threatening complications. 

Doctors may recommend the surgical removal of part of the colon for diverticulosis. 

The decision whether or not to have this surgery is also yours. 

This patient education program will help you better understand the benefits and risks of colon surgery for diverticulosis. 

ANATOMY



The colon is the last part of the intestines, also known as the large intestine. 

Swallowed food goes through the esophagus. 

It then passes through the stomach where it is partially digested. 

Food goes from the stomach to the small intestine where nutrients are further digested and - absorbed. 

Fibers and digested food finally reach the colon. 

In the colon, the rest of the water gets absorbed and stools are formed. 

Stools are then stored in the last part of the colon, the sigmoid and rectum, before being excreted. 

The colon has multiple components:

·         The ascending colon

·         The transverse colon

·         The descending colon

·         The sigmoid colon

·         The rectum and the anus



SYMPTOMS AND THEIR CAUSES

 

Constipation causes stools to become hard. 

This requires the colon to exert more effort to push the stools along. 

Over time, this increased pressure causes the wall of the colon to stick out like pouches. These pouches are called diverticula. 

Most diverticula are located in the sigmoid section of the colon. 

The combination of the pouching, called diverticulosis, and infection results in pain in the abdomen and possible fever. This is called diverticulitis. 

If one of these diverticula ruptures, the infection could spread to the whole abdomen. This is known as peritonitis. This condition could potentially lead to death. 

Tests like sigmoidoscopy and colonoscopy will help your doctor determine the extent of the disease. During these tests, your doctor uses a special scope placed through the rectum to look inside the colon. 

Sometimes a barium enema test may also be needed. This is an X-ray test taken after the colon is filled with liquid barium. 

ALTERNATIVE TREATMENTS

 


Improving your diet by increasing the amount of fiber and liquid that you consume may help. 

Liquid and high-fiber foods increase the bulk of the stools and make them softer and easier to push along in the colon. 

If you develop diverticulitis or infection in the diverticula, you will need to take antibiotics and may even need hospitalization. 

If these measures fail to control the symptoms or if one of the diverticula ruptures, your doctor may recommend an operation to take out the part of the colon involved with the disease.

 

SURGICAL TREATMENT

 

Prior to the surgery, the colon is cleaned thoroughly to decrease the chances of infection. 

This is done using very strong laxatives and enemas or by the patient drinking a gallon of a special liquid the night before surgery to “flush out” the colon. 

This surgery is done under general anesthesia with the patient asleep. 

An incision is made in the middle of the abdomen going from top to bottom. 

The abdomen is then entered. 

The part of the colon involved with diverticulitis is taken out surgically. 

Then the remaining colon is sutured back together. This procedure is called anastomosis.

The following are some examples of what part of the colon is taken out and how the colon is put back together. 

This is the case of diverticulosis involving the ascending colon. 

This is the case of diverticulosis involving the transverse colon. 

This is the case of diverticulosis involving the descending colon. This is the most common type of diverticulosis. 

Sometimes the surgeon has to reroute the colon to the outside of the abdomen. This type of surgery is known as colostomy. This may be necessary:

1.    If the diverticula have ruptured, spreading the infection to the abdomen.

2.    If you have an infection that could not be cured with antibiotics.

3.    If the colon is found to not be clean enough at the time of operation.

If you have a colostomy, then a pouch is placed over the opening of the colon to the outside to collect the stools. Bowel control is lost. However, after 3 to 6 months, the colon can be put back together. This requires another operation. Bowel continuity and control will be re-established. 



RISKS AND COMPLICATIONS

 

This surgery is very safe. There are, however, several possible risks and complications. These are unlikely but possible. You need to know about them just in case they happen. By being informed you may be able to help your doctor detect complications early. 

The risks and complications include those related to anesthesia and those related to any type of surgery. 

Risks of general anesthesia include nausea, vomiting, urinary retention, cut lips, chipped teeth, sore throat and headache. More serious risks of general anesthesia include heart attacks, strokes and pneumonia. Your anesthesiologist will discuss these risks with you and ask you if you are allergic to certain medications. 

Blood clots in the legs can occur due to inactivity during and after the surgery. These usually show up a few days after surgery. They cause the leg to swell and hurt. 

Blood clots can become dislodged from the leg and go to the lungs where they will cause shortness of breath, chest pain and possibly death. It is extremely important to let your doctors know if any of these symptoms occur. Sometimes the shortness of breath can happen without warning. Getting out of bed shortly after surgery may help decrease the risk of blood clots in the legs. 

Some of the risks are seen in any type of surgery. These include:

1.    Infection, deep or at the skin level. Infections can involve the abdominal incision. Deep infections may involve the abdominal cavity itself. This is called peritonitis. Treating deep infections may require long-term antibiotics and possibly surgery.

 

2.    Bleeding, either during or after the operation. This may require a blood transfusion or reoperation.

 

3.    The abdominal incision may break down requiring a second operation.

Other risks and complications are related specifically to this surgery. These, again, are very rare. However, it is important to know about them. 

Structures in the abdomen could be damaged. Such problems can include the following:

 

1.    The spleen or the liver could be injured.

 

2.    The intestines and stomach could be perforated.

 

3.    The kidneys, the urinary bladder, and the connecting tubes (ureters) could be injured.

 

4.    Internal female organs, such as the uterus and ovaries, could also be injured.

 

5.    The blood vessels going to the lower extremities could be affected.

Damage to these structures could lead to permanent damage and the need for other operations. These again are very rare. In extremely rare cases, death may result from these complications. 

Hernias through the incision or incisions are possible. This happens when the internal wall of the abdomen is weak and intestines push under the skin. This may require another operation. 

Another possible complication is the breakdown of the anastomosis, or the area where the two ends of the colon are attached. This can lead to infection in the abdomen requiring another operation and a colostomy. 

Diverticulosis could happen again in another part of the colon. This is why you should change your diet and bowel habits to decrease that possibility. 


AFTER THE SURGERY

 

After the operation is done, you are transferred to the recovery room and then to a regular room. 

You will not be allowed to eat or drink for a few days to allow the anastomosis to heal. 

A tube may be placed in the stomach through the nose for a few days. It sucks out the air and the juices of the stomach. This is to prevent you from getting bloated and nauseated while giving the anastomosis time to heal. 

You will then gradually be allowed to eat food. 

You will go home in a few days, depending on how you are doing. 

Make sure to contact your doctor in case of any new symptoms, such as fever, wound drainage, severe pain, weakness, swelling or infection. 

SUMMARY

 

Diverticulosis is a common condition that may require surgery. 

When surgery is recommended to treat diverticulosis, it is very successful in controlling the symptoms. 

Colon surgery is very safe. Risks and complications are very rare. Knowing about them may help you detect and treat them early if they happen.