Diverticulectomy

People who have mild, brief attacks and who are willing to try long-term dietary changes may be able to avoid surgery. If you have multiple attacks of diverticulitis, surgery may be appropriate.

Surgical treatment, called bowel resection, involves removing the diseased part of the large intestine (partial colectomy) and reconnecting the remaining parts. Depending on the severity and nature of the symptoms, more than one surgery may be needed to correct the problem. When multiple surgeries are needed, the person usually has a colostomy during the time between surgeries. A colostomy is a surgical procedure in which the upper part of the intestine is sewn to an opening made in the skin of the abdomen. Stool passes out of the body at this opening and into a disposable bag. Usually the colostomy is removed at a later time and the intestine is reconnected.

Overall, fewer than 6 out of 100 people who have diverticulitis need surgery.

You may decide to have surgery for diverticulitis if you have:

• Repeated attacks. Surgery to remove the diseased part of the colon often is recommended if you have two or more severe attacks.
• A high risk of repeated attacks (such as in people younger than age 40, or people with an impaired immune system).
• An abnormal opening (fistula) that has formed between the colon and an adjacent organ, most commonly the bladder, uterus, or vagina.

Surgery for diverticulitis may be required if you have complications, including:

• An infected pouch (diverticulum) that has ruptured into the abdominal cavity, especially if a pocket of infection (abscess) has formed.
• An infection that has spread into the abdominal cavity (peritonitis).
• A blocked colon (bowel obstruction) or a narrow spot in the colon (stricture).Infection that has spread through the blood to other parts of the body (sepsis).
• Repeated problems with bleeding or severe bleeding that does not stop with other treatments.

In some cases of diverticulitis, a pocket of infection (abscess) in the abdomen heals on its own. At other times it can be drained without surgery. A needle is passed through the skin into the abscess, and the liquid containing the infection is drained. A computed tomography (CT) scan is used to help the doctor guide the needle into the abscess. Sometimes a plastic drain is placed temporarily in the abdomen to drain the abscess.

Your doctor will ask you questions about your health and do a physical exam if diverticulitis is suspected. Depending on your symptoms, you may have one or more tests to rule out other medical problems that could be causing your symptoms. How much testing you need depends on how bad your symptoms are and how long they have lasted.

Routine tests

These tests may be done any time you see your doctor about abdominal pain or other symptoms.

• A complete blood count (CBC) may show if you have an infection or if you have too few red blood cells in your blood, possibly because of bleeding in the colon.
• A urinalysis may show you have a urinary tract infection.
• An X-ray of your belly may provide clues about the cause of abdominal pain and other symptoms.
• A digital rectal exam looks for tenderness or a mass in the lower pelvic area.
• A fecal occult blood test looks for blood in your stool.
• Tests done as needed

Depending on your symptoms, your doctor may want to do tests such as:

A computed tomography (CT) scan.

This test may be done if symptoms suggest you have a pocket of infection (abscess) in your belly or that a pouch (diverticulum) has burst. The scan also can reveal other possible causes of your symptoms.

A barium enema X-ray.

This X-ray may be used to show diverticula or other possible causes of your symptoms. But an X-ray usually is not done while you are having an attack of diverticulitis. This is because barium might spill into the peritoneum (the lining of the abdominal cavity) if the lining of the colon is torn. A material that works similar to barium but that can dissolve in water (water-soluble contrast) may be used instead.

Flexible sigmoidoscopy and colonoscopy.

These tests may be used if your main symptom is bleeding from the intestine. These tests also may be done to look for narrow spots or growths in the intestine and to rule out ulcerative colitis or cancer. But these procedures are not usually done while you are having an attack of diverticulitis. This is because the scope could tear the lining of the colon. If this happens, the infection could spill into the peritoneum. This would cause a more serious infection.

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