Our Summary

This research paper is about a 62-year-old man who was completely healthy until he started having pain in the lower left side of his abdomen and a fever. During his physical examination, it was found that he had inflammation in the same area. A CT scan revealed that he had an abscess, or a collection of pus, in his pelvis and air outside of his intestines. He was given antibiotics through an IV and had a procedure to drain the abscess.

He was sent home a week after the drain was removed, but he came back with problems in urination and passing air in his urine, so he was given more antibiotics. A colonoscopy, a procedure used to see inside the colon and rectum, showed that he had diverticulosis, a condition characterized by small pouches in the colon that bulge outward, but there were no other abnormalities.

He then had a successful laparoscopic surgery (a minimally invasive procedure) to remove part of his sigmoid colon (the last part of the colon before the rectum) and to repair a fistula (an abnormal connection) between his colon and bladder.

FAQs

  1. What is a sigmoidectomy and why was it performed in this case?
  2. What is a colovesical fistula and how is it treated during a sigmoidectomy?
  3. What were the symptoms that led to the patient’s diagnosis of diverticulosis?

Doctor’s Tip

One helpful tip a doctor might tell a patient about sigmoidectomy is to follow post-operative care instructions carefully, including taking prescribed medications, avoiding heavy lifting, and gradually reintroducing solid foods into the diet. It is also important to stay in touch with your healthcare provider for follow-up appointments and to report any unusual symptoms or complications. Additionally, maintaining a healthy lifestyle with a balanced diet and regular exercise can help promote a smooth recovery process.

Suitable For

Patients who are typically recommended for sigmoidectomy include those with:

  1. Diverticulitis: Sigmoidectomy may be recommended for patients with recurrent or severe diverticulitis that does not respond to conservative treatments such as antibiotics and dietary changes.

  2. Colovesical fistula: Patients with a colovesical fistula, a rare condition where there is an abnormal connection between the colon and the bladder, may require sigmoidectomy to repair the fistula and prevent recurrent infections.

  3. Colon cancer: Patients with colon cancer located in the sigmoid colon may undergo sigmoidectomy as part of their treatment plan to remove the cancerous tissue and prevent further spread of the disease.

  4. Chronic constipation: Patients with severe chronic constipation that does not respond to other treatments may be recommended for sigmoidectomy to remove a portion of the colon and improve bowel function.

  5. Other conditions: Sigmoidectomy may also be recommended for patients with other conditions such as inflammatory bowel disease, colonic stricture, or volvulus (twisting of the colon) that cannot be effectively managed with conservative treatments.

Timeline

  • Patient presents with left lower quadrant pain and fever
  • Physical examination shows left lower quadrant peritonitis
  • Computed tomography scan shows pelvic abscess with extraluminal air
  • Intravenous antibiotics are started and CT-guided percutaneous drainage is performed
  • Drain is removed 1 week after discharge
  • Patient presents with dysuria and pneumaturia one week later and is started on antibiotics
  • Colonoscopy confirms diverticulosis with no other mucosal abnormalities
  • Patient undergoes successful laparoscopic sigmoidectomy with colovesical fistula takedown
  • Recovery period following surgery with monitoring for any post-operative complications

What to Ask Your Doctor

  1. What is the reason for recommending a sigmoidectomy in my case?
  2. What are the potential risks and complications of the sigmoidectomy procedure?
  3. How long is the recovery period after sigmoidectomy surgery?
  4. Will I need a colostomy bag after the surgery?
  5. What dietary and lifestyle changes will I need to make after the surgery?
  6. How often will I need follow-up appointments after the surgery?
  7. Will I need any additional treatments or medications after the sigmoidectomy?
  8. How soon can I expect to return to normal activities after the surgery?
  9. Are there any specific warning signs or symptoms I should watch out for after the surgery?
  10. What are the long-term implications of undergoing a sigmoidectomy for my health?

Reference

Authors: Mendez-Pastor A, Garcia-Henriquez N. Journal: Dis Colon Rectum. 2020 Jan;63(1):26-28. doi: 10.1097/DCR.0000000000001552. PMID: 31804267