Our Summary

This paper is about how to handle emergencies involving a condition called perforated diverticulitis, which is when small pouches in the digestive tract burst and cause a severe infection throughout the abdomen (generalized peritonitis). The authors are looking at the best ways to decide whether to treat with medicine or surgery, what kind of surgery to do if it’s needed, and how to manage the patient’s care both before and after surgery.

Four Italian scientific societies selected experts to look at five big questions in this area. They found that surgery is generally needed if the infection has spread throughout the abdomen or if medicine alone isn’t working. The decision to operate isn’t based just on whether there is air escaping from the digestive tract. The type of surgery chosen depends on what the surgeon sees during the operation and whether or not the patient is in severe septic shock, a life-threatening condition that can happen with serious infections. Other factors to consider include the patient’s general health, age, other diseases they may have, and how well their immune system is working.

For patients who are stable, emergency laparoscopy (a less invasive type of surgery) has benefits over traditional open surgery. Options include removing the affected section and reconnecting the healthy parts, a procedure known as Hartmann’s procedure, or washing out the abdominal cavity. For patients in septic shock, open surgery is usually preferred. Depending on how unstable the patient is, the only viable options might be to remove the affected section without reconnecting the healthy parts, or to control the damage without trying to fix it right away.

After surgery, the main goals are to control the infection, manage pain, and prevent or treat postoperative ileus, a condition where the intestines stop working properly. The authors conclude that each patient is unique and requires an individualized approach, including a thorough evaluation of their overall health, the extent of the infection, and the most suitable surgical procedure.

FAQs

  1. What factors are considered when deciding whether to treat perforated diverticulitis with medicine or surgery?
  2. What type of surgery is generally preferred for patients with perforated diverticulitis who are in septic shock?
  3. What are the main goals of patient care after surgery for perforated diverticulitis?

Doctor’s Tip

One helpful tip a doctor might tell a patient about diverticulitis surgery is to follow their post-operative care instructions carefully, including taking prescribed medications, keeping the surgical site clean and dry, and attending follow-up appointments with their healthcare provider. It’s important to communicate any concerns or changes in symptoms to their doctor promptly to ensure a smooth recovery process. Additionally, maintaining a healthy diet and lifestyle can help prevent future episodes of diverticulitis.

Suitable For

Patients who are typically recommended diverticulitis surgery are those who have a severe infection throughout the abdomen (generalized peritonitis) due to perforated diverticulitis. Surgery is generally necessary if the infection has spread, if medication alone is not effective, or if the patient is in severe septic shock. Other factors to consider when recommending surgery include the patient’s overall health, age, other underlying medical conditions, and immune system function.

For stable patients, emergency laparoscopy may be preferred over traditional open surgery, as it is less invasive. Options for surgery include removing the affected section and reconnecting healthy parts (Hartmann’s procedure) or washing out the abdominal cavity. For patients in septic shock, open surgery is usually the preferred option. The type of surgery chosen will depend on the patient’s stability and the extent of the infection.

After surgery, the main goals are to control the infection, manage pain, and prevent or treat postoperative complications such as ileus. Each patient requires an individualized approach, taking into account their unique characteristics and the extent of the infection. A thorough evaluation is necessary to determine the most suitable surgical procedure for each patient.

Timeline

Overall, the timeline for a patient with diverticulitis before and after surgery can vary depending on the severity of their condition and the type of surgery they undergo. Before surgery, a patient may experience symptoms such as abdominal pain, fever, nausea, and changes in bowel habits. They may undergo diagnostic tests such as CT scans or blood tests to confirm the diagnosis and determine the extent of the infection.

After surgery, the patient will typically stay in the hospital for a few days to recover. They may receive antibiotics to prevent infection, pain medication to manage discomfort, and fluids to prevent dehydration. Physical therapy may be recommended to help with mobility and prevent complications such as blood clots.

Once discharged from the hospital, the patient will need to follow up with their healthcare provider regularly to monitor their recovery. They may need to follow a special diet to promote healing and prevent future flare-ups of diverticulitis. It is important for the patient to communicate any concerns or new symptoms to their healthcare provider to ensure a successful recovery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about diverticulitis surgery include:

  1. What are the risks and benefits of surgery for my specific case of diverticulitis?
  2. What type of surgery do you recommend for me and why?
  3. What is the recovery process like after surgery and how long can I expect to be in the hospital?
  4. What are the potential complications of surgery and how will they be managed?
  5. Will I need to make any lifestyle changes or follow a special diet after surgery?
  6. How long will it take for me to fully recover and resume normal activities?
  7. Are there any alternative treatments to surgery that I should consider?
  8. How often will I need follow-up appointments after surgery and what should I expect during these visits?
  9. Can you explain the specific steps of the surgical procedure and what I can expect during the surgery itself?
  10. Are there any specific questions or concerns you recommend I discuss with the anesthesiologist before surgery?

Reference

Authors: Nascimbeni R, Amato A, Cirocchi R, Serventi A, Laghi A, Bellini M, Tellan G, Zago M, Scarpignato C, Binda GA. Journal: Tech Coloproctol. 2021 Feb;25(2):153-165. doi: 10.1007/s10151-020-02346-y. Epub 2020 Nov 5. PMID: 33155148