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Diverticulitis

Diverticuli are herniations in the muscular layer of the colon that make small, saclike swellings. Diverticulitis occurs when diverticuli become inflamed and infected. If these areas become infected often or the infections are severe, then surgery may be indicated. The surgical treatment of diverticulitis involves removing the portion of the affected colon, which is called a colectomy. Our GW Colorectal surgeons offer minimally invasive techniques for doing so, including laparoscopic and robotic approaches.

What is diverticular disease?

Diverticular disease is an infection in the tiny pouches that some people get in their colon. The pouches are called diverticula. These pouches bulge out through weak spots in your colon. The pouches can become inflamed (red, swollen) or infected.

Diverticular disease includes these 2 health problems:

  • Diverticulosis. When you have tiny pouches, or diverticula, in your colon.
  • Diverticulitis. When the pouches in your colon get infected.

About half of all Americans over age 60 will have diverticulosis. Some people with diverticulosis also get diverticulitis.

What causes diverticular disease?

Experts are not sure what causes diverticular disease. They think it might happen when you don’t eat enough fiber. Fiber is the part of fruits, vegetables, and grains that the body can’t digest.

Fiber helps make your stools soft and easy to pass. Eating more fiber helps stop constipation.

Constipation is the main cause of greater pressure in your colon. When you are constipated, your muscles strain to move stool that is too hard. The extra pressure from this straining makes the weak spots in your colon bulge out. These pouches that bulge out are the diverticula.

Experts do not know what causes the infection that leads to diverticulitis. They think the infection may start when stool or bacteria are caught in the diverticula.

Who is at risk for diverticular disease?

Experts don’t know for sure if your diet affects your risk of getting diverticular disease. But you are more at risk for the disease if you:

  • Are over 50 years old
  • Are male
  • Have diverticulosis
  • Are obese
  • Don’t get enough exercise
  • Use nonsteroidal anti-inflammatory drugs (NSAIDS)
  • Smoke

What are the symptoms of diverticular disease?

Each person’s symptoms may vary. Symptoms may include:

  • Diverticulosis. You can have diverticulosis and not have any pain or symptoms. But symptoms may include mild cramps, swelling or bloating, and constipation. These symptoms can also be caused by irritable bowel syndrome, stomach ulcers, or other health problems. These symptoms don’t always mean that you have diverticulosis.
  • Diverticulitis. The most common symptom of diverticulitis is belly or abdominal pain. The most common sign that you have it is feeling sore or sensitive on the left side of your lower belly. If infection is the cause, then you may have fever, nausea, vomiting, chills, cramping, and constipation.
  • Diverticular colitis. This is when the colon gets inflamed (colitis) as a result of the diverticular disease. This is less common than diverticulitis.

The symptoms of diverticular disease may look like other health problems. Always see your healthcare provider to be sure.

How is diverticular disease diagnosed?

Your healthcare provider will look at your past health and do a physical exam. He or she may also use some of the following tests:

  • X-rays.
  • Digital rectal exam. This test checks if you have problems in the anus or rectal area. Your healthcare provider will gently put a gloved, lubricated finger into your rectum. Using his or her finger, your healthcare provider will check the muscle that closes off the anus.
  • A stool sample. This test checks for any abnormal bacteria or parasites in your digestive tract. To do this, a small stool sample is taken and sent to a lab.
  • CT scan. This test shows detailed images of any part of the body, such as the bones, muscles, fat, and organs. This is used to check for complications f diverticular disease like diverticulitis.
  • Barium enema or lower GI (gastrointestinal) series. This is an X-ray exam of your rectum, the large intestine, and the lower part of your small intestine. You will be given a metallic fluid called barium. Barium coats the organs, so that they can be seen on an X-ray. The barium is put into a tube and inserted into your rectum as an enema. An X-ray of your belly will show if you have any narrowed areas (strictures), blockages, or other problems.
  • Virtual colonoscopy. A CT (CAT) scan that checks your colon using air and contrast.
  • Flexible sigmoidoscopy. This test checks the inside of part of your large intestine. It helps to tell what is causing constipation. A short, flexible, lighted tube (sigmoidoscope) is put into your intestine through the rectum. This tube blows air into your intestine to make it swell. This makes it easier to see inside. A tissue sample (biopsy) can be taken if needed.
  • Colonoscopy. This test looks at the full length of your large intestine. It can help check for any abnormal growths, tissue that is red or swollen, sores (ulcers), or bleeding. A long, flexible, lighted tube (colonoscope) is put into your rectum up into the colon. This tube lets your healthcare provider see the lining of your colon and take out a tissue sample (biopsy) to test it. He or she can also treat some problems that may be found.

How is diverticular disease treated?

Your healthcare provider will make a care plan for you based on:

  • Your age, overall health, and medical history
  • How serious your case is
  • How well you handle certain medicines, treatments, or therapies
  • If your condition is expected to get worse
  • Your opinion and what you would like to do

Experts suggest eating 20 to 35 grams of fiber each day. Your provider may tell you to eat more foods that have fiber, such as:

  • Whole grain breads, cereals, and other items
  • Fruit, such as berries, apples, and peaches
  • Vegetables, such as broccoli, cabbage, spinach, carrots, asparagus, and squash
  • Beans

Treatment for diverticulitis may also include:

  • Pain medicines
  • Medicines to fight infection (antibiotics)
  • Medicines to control muscle spasms
  • Letting your colon rest by having a liquid diet and staying in bed
  • Bowel rest or eating only clear liquids for some time

You may need to stay in the hospital if you have a bad attack with severe pain or infection. In some cases surgery may be needed.

What are the complications of diverticular disease?

Diverticular disease can cause other health problems such as:

  • Infection
  • Holes or tears
  • Blockages
  • Bleeding
  • Colitis (inflammation of the colon)

Can diverticular disease be prevented?

Experts don’t know how to keep diverticular disease from happening. But once you have diverticulosis it may be possible to decrease your risk of diverticulitis by eating a high-fiber diet. You do not need to avoid corn, nuts, or seeds.

Living with diverticular disease

If you have diverticulosis, follow your healthcare provider’s advice. Some people with diverticulosis will get diverticulitis. A few will have diverticular bleeding.

Key points

  • Diverticular disease is when symptoms happen from diverticulosis (the pouches) or diverticulitis (infection or inflammation of the pouches)
  • The most common symptom is belly or abdominal pain.
  • The most common sign that you have it is feeling tender around the left side of the lower abdomen.
  • To see if you have diverticular disease, your doctor may order tests that look at your intestine from the outside (such as CT scan or virtual colonoscopy) or inside (such as colonoscopy).
  • Treatment may include eating more fiber. However, during attacks of diverticulitis, you may be told to remain on clear liquids or low fiber foods for some time.
  • You may need to stay in the hospital if you have a bad attack with severe pain or infection.
  • Diverticular disease can cause other health problems such as infections, blockages, tears, or bleeding.

Colectomy

Hemicolectomy, partial colectomy, or segmental resection

Procedure overview

A colectomy is a type of surgery used to treat colon diseases. These include cancer, inflammatory disease, or diverticulitis. The surgery is done by removing a portion of the colon. The colon is part of the large intestine. When treating cancer, the surgeon will often remove the part of the colon that appears to have cancer. He or she will also remove another small part on either side of the cancer area. And he or she will remove some nearby lymph nodes. The remaining parts of the colon are then attached to each other. Or an opening to the outside of the body (stoma) is created. This is called a colostomy.

A colectomy can be done in 2 ways:

  • Open colectomy. This is done through a long, vertical incision on your belly.
  • Laparoscopic-assisted colectomy.This is done with small incisions. A tiny video camera is put into 1 of the incisions. This is done to help the surgeon see the colon. This surgery may be a choice for some cancers. People often have less pain and recover quicker because of the small incisions.

Reasons for the procedure

A colectomy is usually done if colon cancer is in its earlier stages. If the cancer has grown past the early stages, a more extensive colectomy may be an option.

Your healthcare provider will advise a colectomy if your medical team believes it will give you the best chance of survival or improve your quality of life.

Risks of the procedure

All surgery has risks. Talk with your healthcare provider before the surgery if you have concerns. Risks of a colectomy include:

  • Reactions to anesthesia
  • Blood clots in the legs or lungs
  • Internal bleeding
  • Infection at the skin incision site or inside the belly
  • Hernia
  • A leak where the intestines are sewn together
  • Damage to nearby organs
  • Scar tissue (adhesions) in the stomach, which can block the intestines

Before the procedure

Before a colectomy you will need a complete evaluation by your medical team. This is done to stage your cancer and plan your surgery. This may include special X-rays, blood tests, and an EKG. You may have a colonoscopy. This is a procedure to look inside your colon and rectum. It is done with a flexible, lighted scope and a tiny video camera.

Here is what to expect before surgery:

  • Your bowels must be empty for the surgery. You will need to make changes to your food and drink intake on the days before surgery. Follow all of your healthcare team’s instructions.
  • You may need to do bowel prep 1 to 2 days before the procedure. This may include a laxative and enemas to clean out the bowel.
  • You may be told to only drink clear liquids or broth the day before surgery. You may also be told not to have any food or drinks at all up to 12 hours before the procedure.
  • You may need to stop taking some medicines in the week before the surgery. This includes any medicines that thin the blood.

Your healthcare provider may give you other instructions.

During the procedure

Here is what to expect during surgery:

  • You will have general anesthesia for the surgery. This is medicine that causes you to sleep during the procedure.
  • For an open colectomy, the surgeon will make a long cut (incision) on your stomach. For a laparoscopic-assisted colectomy, he or she will make several smaller incisions.
  • The surgeon will remove part of your colon.
  • The 2 open ends of the colon will be attached. Or a stoma will be created.
  • The lymph nodes near the site of the cancer will be removed. Surgeons often remove at least 12 of these lymph nodes.
  • Once the surgery is done, the incision is closed.

After the procedure

You will likely be in the hospital for 3 to 7 days. You'll likely also need to take pain medicine for several days. You may be allowed some liquids as your colon begins to recover.

After a few days, you may be able to eat some solid food again. Your healthcare provider will schedule follow-up appointments to check on your progress.

Before leaving the hospital, make sure you know what problems or side effects to watch for. Watch your wounds for signs of problems, such as swelling.

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