UW Health Colon and Rectal Surgery specialists in Madison, Wisconsin provide comprehensive evaluation and surgical management of diverticular disease.
Diverticular Disease (Diverticulosis/Diverticulitis)
Diverticular disease is a benign condition that affects the colon.
Diverticula are small outpouchings or pockets of the intestinal wall that occur along general points of weakness. Diverticula can involve all areas of the intestinal tract but most commonly involve the sigmoid colon.
This condition is very common in western cultures and affects more than 30 percent of patients over 60 and 60 percent of those over the age of 80 years old.
Symptoms of Diverticular Disease
Most commonly, individuals with diverticular disease experience no symptoms and may only discover the presence of diverticula on routine colonoscopy during the course of screening for cancer.
The presence of diverticula in the colon does not require treatment. Only when diverticula become symptomatic is intervention warranted.
Inflammation of the diverticula leads to a clinical condition termed diverticulitis.
The most common symptom of diverticulitis is pain in the lower left abdomen. Other symptoms may include:
- Change in bowel habits
- Decreased appetite
Bouts of diverticulitis can be complicated by perforation, abscess formation, and frank peritonitis (a state of general inflammation and infection of the abdominal cavity resulting from perforation, manifested by severe abdominal pain).
In some instances, diverticula can also lead to an abnormal connection between the colon and other structures such as the bladder. This abnormal connection is known as fistula formation.
Diagnosis of Diverticular Disease
The diagnosis of diverticulitis is not always straightforward. The presence of pain in the left lower quadrant does not make the diagnosis by itself and other tests will be required.
Blood tests examining the white blood cell count and hemoglobin concentration will be necessary.
Computed Tomography (CT) can demonstrate inflammation around diverticula and thickening of the colon. Additionally, diverticula can be identified on CT scan as well as the possible complications of a diverticulitis, such as abscess or fistula.
Once the initial flare has calmed, a colonoscopy will be required if one has not occurred within a recent time frame.
Treatment of Diverticular Disease
Uncomplicated diverticulitis can often be managed as an outpatient with oral antibiotics. Others may require hospital admission and IV antibiotics. If the pain improves, surgical intervention may not be warranted. However, in patients who do not get relief or suffer multiple recurrent bouts of diverticulitis, surgical resection may be beneficial. Additionally, patients who have other severe medical problems or have a compromised immune system (such as those with solid organ transplants) may benefit from earlier surgical intervention. Emergency surgical intervention may be required for patients presenting with evidence of complicated disease.
The type of surgery required is dependent upon the clinical situation.
Those patients presenting in the acute setting with severe abdominal pain, fever, and radiographic documentation of perforation (complete penetration) may require an emergency operation. Most often these patients are treated with removal of the portion of colon involved and placement of a temporary colostomy (bringing the bowel through the skin). In the majority of patients this colostomy and can be reversed after a period of 4-6 months.
Those patients presenting for elective surgical intervention can generally be treated with a resection and primary anastomosis (connection).