Diverticular disease, also known as diverticulosis, is a common condition of the colon that occurs when small pouches (diverticula) form in the intestinal wall. In most cases, these pouches are asymptomatic and do not pose a serious problem. However, when they become inflamed or infected, they can lead to a more serious condition known as diverticulitis, which may require surgical treatment in specific cases. Below, we discuss the situations in which surgery is necessary and the approaches available.
What is Diverticular Disease and Diverticulitis?
- Diverticulosis:
○ Presence of diverticula in the colon without inflammation or obvious symptoms.
○ It is often detected incidentally during colonoscopy or testing for other reasons. - Diverticulitis:
○ Inflammation or infection of one or more diverticula.
○ May cause severe abdominal pain, fever, changes in bowel habits and other associated symptoms.
In severe cases, it can lead to complications such as abscesses, perforations or fistulas.
When is Surgery Necessary?
Surgery is not necessary for all patients with diverticulitis. In most cases, conservative treatment, such as antibiotics and dietary changes, is sufficient. However, there are specific situations in which surgery is the best option:
- Recurrent Diverticulitis:
If you have had multiple severe episodes of diverticulitis that affect your quality of life, surgery may be considered to prevent future flare-ups. - Serious Complications:
Abscesses: If an abscess forms that cannot be drained with minimally invasive techniques.
Intestinal perforation: A perforation can lead to peritonitis, a serious abdominal infection that requires immediate surgery.
○ Fistulas: Abnormal connections between the colon and other organs that do not respond to other treatments.
○ Intestinal obstruction: Blockage of the colon due to severe inflammation or scarring. - Immunosuppression:
Patients with weakened immune systems (e.g. organ transplants or autoimmune diseases) may require surgery to avoid serious infections. - Diverticular haemorrhage:
In rare cases, diverticula can cause massive bleeding that is not controlled by non-surgical techniques.
Types of Surgery for Diverticular Disease
Surgery to treat diverticulitis can be performed in different ways, depending on the severity of the case and the general health of the patient:
- Colon Resection (Colectomy):
○ The affected part of the colon is removed and the healthy sections are reconnected.
○ It can be performed as open or laparoscopic (minimally invasive) surgery. - Temporary or Permanent Colostomy:
In severe cases, where the colon cannot be reconnected immediately, a temporary colostomy is created to allow the bowel to heal.
○ In extreme situations, the colostomy may be permanent. - Abscess Drainage:
Before definitive surgery, it may be necessary to drain an abscess using image-guided procedures.
Benefits and Risks of Surgery
Benefits:
● Prevention of future episodes of diverticulitis.
Resolution of serious complications such as abscesses or perforations.
● Improved quality of life after eliminating the source of the problem.
Risks:
● Post-surgical infection.
● Complications such as anastomotic leaks (at the colon connection).
● Need for colostomy in some cases.
Conservative Treatment vs. Surgery
In most cases, the first line of treatment for diverticulitis includes:
Bowel rest: Fasting or liquid diet to allow the colon to rest.
Antibiotics: To treat bacterial infections.
● Lifestyle changes: High fibre diets to prevent future episodes.
However, when these measures are not effective or serious complications develop, surgery becomes a necessary and definitive solution.