Question

Diverticulitis - Role Of Surgery In Managing It!

Dr.Parthasarathy G · Accepted Answer

With more than 1 million cases reported every year in India, the condition is one of the most significant causes of hospital admissions and outpatient visits. A few otherwise common conditions may sometimes become acute, causing intense trauma, and one such is diverticulitis.

Although most people affected with diverticulitis can be treated by medical procedures, some of them would require surgical intervention. It is only required when medical treatment is not amenable, or the disease does not respond to the medical therapy. But it should be noted that Acute diverticulitis with free perforation is a fatal condition which requires emergency surgery.

Medical science has thoroughly evolved the understanding of the natural history and pathophysiology of Diverticulitis. Moreover, non-surgical management and improvements in diagnostic methods have also led to crucial alterations in the treatment recommendations. The present practice guidelines are tailored to the needs of individual patients considering their risk factors, persistent symptoms, and individual preferences.

Who requires surgery in the management of diverticulitis?
Patients suffering from complicated acute diverticulitis with pneumoperitoneum or extraluminal abscess are more likely to require urgent operation compared to the patients with colonic inflammation. Such patients are also more prone to experience complications as well as perforation even after no-operative management.

Doctors recommend undergoing surgery if you are suffering from recurrent attacks of diverticulitis. Also, people under the age of 40 years or people with an impaired immune system who experience repeated attacks should also undergo surgery at the earliest. Moreover, people with an abnormal opening or fistula forming in between the colon and adjacent organ which could include the uterus, bladder or vagina also need an urgent surgical treatment.

The surgery for diverticulitis may also be recommended to fend off certain complications. For instance, if the diverticulum has been infected and ruptured into the abdominal cavity forming a pocket of infection, then surgery is used for draining the abscess. Besides, surgery is done to cure an infection that has spread into the abdominal cavity, blockage of colon, narrow spot in the colon and infection that has spread through the blood to other parts of the body.

What are the surgery choices for diverticulitis?
It is estimated that less than 6 people out of 100 people affected by the diverticulitis need surgical intervention. Surgical treatment involves removal of the diseased portion of the large intestine and reconnecting the remaining parts. Sometimes, more than one surgery is required to correct the disorder in case the condition is very severe.

When multiple surgeries are required, the affected person usually requires a colostomy during the time span between the surgeries. It is generally left at the discretion of the surgeon to decide whether a patient requires single or multiple surgeries.

So, if you have this problem, thoroughly discuss your options with your doctor to decide on the course of action to pave the path towards a complete cure.

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