Diverticulitis (colitis) is an inflammation of a portion of the colon. The inflammation and infection occurs at a place on the colon known as a divertcula. Diverticula are an outpouching on the colon wall that forms over time caused by diet and constipation. These out pouchings usually occur in the sigmoid colon located on the lower left side of the body.
Symptoms
Patients with diverticulitis often have pain in the left lower abdomen. Many have fever and some have nausea and vomiting. Minor cases can usually be managed with antibiotics by mouth at home. Multiple episodes can result in a more complicated diverticulitis requiring an operation.
Complicated Diverticulitis
Complicated diverticulitis usually requires a stay in the hospital. Some patients’ first attacks can present in this way. Antibiotics are given through an IV and patients are asked not to eat until the pain improves. Issues that complicate diverticulitis include multiple episodes resulting in fever and illness. Another issue is micro perforation where the intestine actually has a very small hole than can seal off on its own. Some patients may present with an abscess (pus ball). Others may even present with a connection between their colon and bladder resulting in a urinary tract infection.
Treatment
Complicated diverticulitis should be treated with surgery especially if the patient has had more than one episode. Emergency surgery may be required. Otherwise, the patient will be treated with antibiotics and usually go home. A patient should have a colonoscopy if one has not been performed recently.
Surgery
Diverticulitis surgery that is not performed as an emergency can often be done laparoscopically. A laparoscopic sigmoid colectomy is when four or five small incisions are made and the affected portion of the sigmoid colon is removed with the assistance of a camera known as a laparoscope.
This surgery has many advantages. It prevents further episodes and the need for emergency surgery. Recovery time and hospital stays are much shorter than with the traditional open procedure. In addition, the scars are much smaller with less pain. Patients usually stay in the hospital from 2 to 7 days and return home when they are able to eat and move their bowels.
Emergency surgery is still required for some patients especially when they have complicated diverticulitis. This procedure is usually open and may require a colostomy (stooling into a bag). A colostomy prevents the connection between the bowels from becoming infected and falling apart when the bowel has not been prepared (stool removed). The colostomy is then reversed (normal bowel connection) in a few months. This reversal procedure can often be done with the assistance of the laparoscope and small incisions.