Our Summary

Diverticular disease, a condition affecting the digestive tract, is a common issue that still struggles with optimal care due to its varying stages - acute, chronic, and recurrent. This research paper reviews the evolution of treatment for this disease, which was rarely mentioned before the 1900s, and became more common in developed countries due to dietary changes.

In the past, prompt surgical intervention was recommended to avoid complications. However, recent data suggests that medical management can be effective even after repeated episodes, and surgery may not always be necessary. The severity of the disease can now be graded more accurately, allowing for less invasive treatment options.

A high fiber diet seems to lower the chances of getting diverticulitis, a condition where the diverticula (small pouches in the digestive tract) get inflamed or infected. It was previously believed that eating nuts, corn, popcorn, and seeds should be avoided to prevent diverticulitis, but this has been disproven.

Diverticulosis, the condition of having diverticula, is a common occurrence, especially among the elderly. It can lead to diverticulitis in about 5-25% of cases. This disease results in significant healthcare costs due to emergency department visits and hospital admissions.

Diverticulitis can present in a variety of ways, but is most commonly associated with abdominal pain, fever, and general feelings of unwellness. Diagnosis is usually done through a multi-detector CT scan. Depending on the severity of the case, it may be managed as an outpatient treatment or may require hospitalization. The use of antibiotics is being reevaluated as it appears that they may not always be necessary.

There are two types of acute diverticulitis: complicated and uncomplicated. Uncomplicated diverticulitis is when the inflammation is limited to the colon wall and surrounding tissues. Complicated diverticulitis involves additional issues like perforation, abscess, fistula, stricture, or obstruction. These types require different treatments.

After an episode of acute diverticulitis, a colonoscopy is usually recommended to rule out other conditions like colorectal cancer or inflammatory bowel disease. However, the necessity of this procedure is being questioned.

Surgical treatment for diverticulitis varies depending on multiple factors like patient age, comorbidities, severity of disease, and surgeon preference. The surgical approach can include loop colostomy, sigmoidectomy with colostomy, and sigmoidectomy with primary colorectal anastomosis.

In conclusion, the management of diverticular disease requires a tailored approach based on patient, disease, and surgeon factors in order to achieve optimal outcomes.

FAQs

  1. Is surgery always necessary for the treatment of diverticulitis?
  2. What are the different types of surgical treatment options for diverticulitis?
  3. Why is a colonoscopy recommended after an episode of acute diverticulitis and is it always necessary?

Doctor’s Tip

One helpful tip a doctor might tell a patient about diverticulitis surgery is to follow post-operative care instructions closely to promote healing and reduce the risk of complications. This may include taking prescribed medications, following a special diet, avoiding strenuous activities, and attending follow-up appointments with your healthcare provider. It’s important to communicate any concerns or changes in symptoms to your doctor promptly to ensure proper management of your condition.

Suitable For

Patients who may be recommended diverticulitis surgery typically include those with recurrent or severe episodes of diverticulitis, those with complications such as abscesses or fistulas, those who do not respond well to medical management, and those with a high risk of developing complications in the future. Additionally, patients who have a history of recurrent diverticulitis or who have had multiple hospitalizations for the condition may also be considered for surgery. Ultimately, the decision to undergo surgery for diverticulitis should be made in consultation with a healthcare provider based on the individual patient’s specific circumstances and needs.

Timeline

Before diverticulitis surgery, a patient may experience symptoms such as abdominal pain, fever, and general feelings of unwellness. They may undergo a multi-detector CT scan for diagnosis and may be managed with antibiotics and possibly hospitalized depending on the severity of the case. After an episode of acute diverticulitis, a colonoscopy may be recommended to rule out other conditions.

After diverticulitis surgery, the patient may have a different treatment approach depending on factors like age, comorbidities, severity of disease, and surgeon preference. Surgical options may include loop colostomy, sigmoidectomy with colostomy, and sigmoidectomy with primary colorectal anastomosis. The goal of surgery is to manage complications such as perforation, abscess, fistula, stricture, or obstruction. Overall, the management of diverticulitis requires a tailored approach to achieve optimal outcomes.

What to Ask Your Doctor

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

  1. What are the potential risks and complications associated with diverticulitis surgery?
  2. What are the success rates of diverticulitis surgery in terms of resolving symptoms and preventing future episodes?
  3. How long is the recovery process after diverticulitis surgery and what can I expect in terms of post-operative care?
  4. Are there alternative treatment options to surgery for diverticulitis that I should consider?
  5. How will diverticulitis surgery impact my quality of life in the long term?
  6. Will I need to make any dietary or lifestyle changes after diverticulitis surgery?
  7. How frequently will I need follow-up appointments after diverticulitis surgery?
  8. Are there any specific factors about my case that make me a better or worse candidate for diverticulitis surgery?
  9. What is the experience of the surgical team in performing diverticulitis surgery?
  10. Are there any specific questions or concerns I should discuss with a colorectal specialist before proceeding with diverticulitis surgery?

Reference

Authors: Hawkins AT, Wise PE, Chan T, Lee JT, Glyn T, Wood V, Eglinton T, Frizelle F, Khan A, Hall J, Ilyas MIM, Michailidou M, Nfonsam VN, Cowan ML, Williams J, Steele SR, Alavi K, Ellis CT, Collins D, Winter DC, Zaghiyan K, Gallo G, Carvello M, Spinelli A, Lightner AL. Journal: Curr Probl Surg. 2020 Oct;57(10):100862. doi: 10.1016/j.cpsurg.2020.100862. Epub 2020 Jul 18. PMID: 33077029