What Is Diverticulitis?
Small pouches can be formed in the walls of the intestine. These pouches are called diverticula and the condition is called diverticulosis. When these diverticula get inflamed or infected they can cause a condition called diverticulitis.
Diverticulitis can happen in any area of the gastrointestinal tract but is most commonly found in the large intestine. In particularly in the sigmoid colon.
What Causes Diverticulitis?
The cause of diverticulosis is not completely understood. Some studies attribute the disease to low fiber diets and/or chronic constipation.
The disease is more common in Western Hemisphere countries where a low fiber diet predominates. In countries were fiber consumption is higher the disease is relatively uncommon.
When the diverticula gets occluded accumulation of bacteria can happen and diverticulitis develops. Some suggest that occlusion of the pockets can happen with certain foods, like seeds, nuts, corn or other hard to digest food particles. Also, hard stool can contribute to the disease. Unfortunately, a recent study showed no relationship with diverticulitis and diet modifications.
So the short answered is that we really don’t know the exact cause of diverticulosis.
Symptoms Of Diverticulitis
Patients with diverticulosis are mainly asymptomatic. Some patients may present to the hospital with diverticular bleeding. In some cases, the bleeding can be severe requiring hospital admission, blood transfusions, and other treatments in order to control the bleeding.
Diverticulitis, on the other hand, is mainly associated with pain. The most common area where people get diverticulitis is in the sigmoid colon. For that reason, the most common presentation is a pain in the left lower area of the abdomen.
Other symptoms can include fever, chills, nausea, vomiting, constipation or diarrhea. Bleeding is rarely seen with diverticulitis.
How Is Diverticulitis Diagnosed?
Most physicians will order a routine blood test. In the setting of inflammation is normal to find an elevated white blood cell count.
At this point, the diagnosis is highly suspected but radiologic evaluation is used for confirmation and also to evaluate the severity.
The supplemental image of the CT scan shows clear evidence of diverticulitis with inflammation of the colon and a contained perforation with a fluid collection or abscess.
A colonoscopy is usually not indicated in the acute setting due to an increased risk of perforation. Most physicians will recommend a follow-up colonoscopy 6-8 weeks after the episode.
How Is It Treated?
The treatment of diverticulitis is highly dependent on the severity. For mild episodes, most patients will be treated at home with antibiotics by mouth and a liquid to a bland diet. The majority of the patients in this group will see improvement within several days.
Patients with more significant symptoms will routinely be admitted to the hospital. The patients will be placed on intravenous antibiotics and usually nothing to eat for 24-48 hours. As the patients improve the diet will be advanced and after several days they will be discharged home on antibiotics by mouth.
For the patients that present with severe pain or free perforation of the large intestine surgical intervention may be needed. The patients will be admitted to the hospital and placed on antibiotics by vein. A surgeon is usually consulted and the surgeon will decide if surgical exploration is warranted. The surgical approach is usually dependent on the surgeon’s skill set and the patient condition at the time of the evaluation.
Surgery For Diverticulitis
Open Colon Resection
Open colon surgery has been done for over a century. In recent years advances in laparoscopy has made possible to do colon surgeries minimally invasive. Unfortunately, some patients are not candidates for this approach.
Many patients that present to the emergency room with severe diverticulitis that requires surgery will end up with open surgery. That is particularly true in case with significant contamination of the abdominal cavity.
Sometimes the only and best way to clean the abdomen and to resect a very inflamed piece of colon is with the surgeon’s hands. Another thing to consider is surgeon availability. Many times when the patient presents to the emergency room they will call the surgeon on call and sometimes that might not be the best option for the patient.
For patients that present electively with chronic diverticulitis that are candidates for surgery, an open approach can also be performed but a laparoscopic or robotic approach is probably a better alternative.
Surgery For Diverticulitis
Laparoscopic Colon Surgery
Laparoscopic colon surgery for diverticulitis is usually reserved for elective cases. Surgery is routinely done with 3-4 small incisions. Surgery time ranges between 2-4 hours, depending on the amount of inflammation and/or previous surgeries.
The laparoscopic approach has many benefits for the patient. From faster recovery to regular activities to less pain. Many studies have also shown less blood loss, shorter hospital stay, and less overall complications.
Dr. Caban has ample experience in advanced laparoscopic surgery. He has performed hundreds of minimally invasive colon resections for diverticulitis. In Ocala, no other surgeon has more experience or better skills doing this type of surgery than Dr. Caban.
Surgery For Diverticulitis
Robotic Colon Surgery
Robotic surgery is very similar to laparoscopic surgery with some minor differences. Robotic colon surgery is also done with 3-4 small incisions and the operative time also ranges between 2-4 hours. Hospital stay, post-operative pain, overall complications and return to regular activities is relatively identical to laparoscopic surgery.
The main advantage of robotic surgery especially for chronic recurrent diverticulitis is the arm articulation. Laparoscopic instruments are rigid, that limits the ability to reach tight places in difficult angles. The DaVinci robotic platform is also very strong. Chronically inflamed tissues can be very hard to dissect and the extra strength from the robotic platform can be very advantageous.
Dr. Caban usually reserves the DaVinci surgical system for cases were significant colon inflammation is expected. That will maximize the odds of completing the surgery using minimally invasive techniques.
Post Operative Period
What Happens After Colon Surgery For Diverticulitis?
After colon surgery, the patients will be admitted to the hospital for observation. Most patients will be admitted for an average of 3-7 days. For the first 2-3 days, the patient will be without eating awaiting for the bowel to start functioning again. Once the bowel function returns the diet will be advanced slowly. Most patients will go home eating a regular diet.
At discharge from the hospital, you will be given a prescription for pain medications and other basic instructions.
You will follow up with Dr. Caban in 2-3 weeks and then at three months.
Most patients that have office type job can expect to return to work after one to two weeks after leaving the hospital. For those of you that have a labor intense job were heavy lifting more than 15-20 pounds is necessary, you should account for 4-6 weeks out of work or sooner if light duty is an option.
Other activities like playing golf, pickleball, bowling or any other sports were using the core muscles is necessary should be postponed for 4-6 weeks. Swimming should be limited until the incisions are completely healed.
What People are Saying
“Dr. Angel Caban performed my surgery almost 5 years ago on 6/2/2014. He is a kind doctor and always treated me fairly. I always felt welcome in his office. I recommended him to many over the past 5 years”.
“Me encanta no lo cambio. Exelente el doctor caban y su personal. Muy buen grupo”.
“Another successful experience”
“Dr. Caban did my colon resection and did an outstanding job all the way across the board. I highly recommend him as well”.
“Very fortunate to have him”
“I have the privilege of working with Angel M Caban in the hospital environment. I also have had him be the surgeon to one of my family members. I would like everyone to know that he is a great surgeon. We are fortunate to have him here in Ocala. He is personable, easy to talk too and has excellent bedside manners”.
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