A Surgeon’s Thought on Diverticulitis By Matthew J. Finnegan, M.D.
Dr. Matthew J. Finnegan is a robotic general and colorectal surgeon with Shore Physicians Group in Somers Point. His surgical team operates at Shore Medical Center.
Have you ever had a colonoscopy, or another imaging study and been given results describing “diverticulosis” observed in your colon? Have you been told you have a condition called “diverticulitis“?
What is diverticulosis?
Diverticulosis occurs when small pouches, or sacs, form and push outward through weak spots in the wall of your colon. These pouches are most common in the lower part of your colon, called the sigmoid colon. When one or more of these pouches become inflamed or infected, the condition is called diverticulitis.
The causes of diverticulitis include genes, lack of fiber, sedentary lifestyle, obesity, smoking, immunosuppression, age, NSAIDs, alcohol, and patients with multiple comorbidities like diabetes and kidney disease.
Left-sided colonic diverticulosis remains more common among elderly patients; however, a dramatic rise in its incidence has been seen in younger age groups in recent years. Recent evidence suggests that the lifetime risk of developing acute left-sided colonic diverticulitis is about 4% among patients with diverticulosis, and data suggest that up to one-fifth of patients with acute diverticulitis are under 50 years of age.
What symptoms are associated with diverticulosis?
While most people with colonic diverticulosis remain asymptomatic, approximately 20% experience abdominal symptoms, episodes of diverticulitis, or bleeding. Symptoms of diverticular disease can be acute or chronic, ranging from gastrointestinal symptoms similar to those of irritable bowel syndrome, like crampy lower abdominal pain or abdominal discomfort, bloating, constipation and diarrhea; to acute symptoms resembling appendicitis, like fever, acute abdominal pain, elevated white blood cell count, chronic abdominal pain, or recurrent severe attacks of abdominal pain associated with fever.
How do you treat diverticulitis?
Mild disease is treated with a low fiber diet and addressing the etiology of symptoms. If symptoms don’t resolve, further workup with a CT scan and blood work ordered to rule out more severe disease and starting oral antibiotics. Patients with severe disease may need admission to the hospital for IV antibiotics, and patients who do not respond to treatment or have recurrent symptoms as an outpatient will see a surgeon for a consultation.
The indications for urgent or emergent surgery are well-defined. The indication for elective surgery is based on a multidisciplinary evaluation, with significant input from the patient, on the disease’s effect on quality of life. We discuss the risks and benefits of surgical intervention versus conservative medical management with patients and their families.
After the patient is evaluated, imaging and testing are completed, and a diagnosis is made, we must prepare our patients for surgery, focusing on nutrition and enhanced recovery after surgery. We educate and prepare our patients to promote better outcomes and fewer complications. Patients undergo bowel preparation prior to surgery. The surgery consists of a robotic-assisted laparoscopic removal of the sigmoid colon with reconnection of the bowel. Most patients are hospitalized for 3-5 days. (The length of stay in the hospital depends on their pre-existing disease, age and how complicated their disease is.)
Although the pendulum has moved toward conservative management, many patients with chronic recurrent disease benefit from elective surgery. Surgical consultation can give patients more information on treatment options. We recommend a patient-specific, tailored approach to elective surgical indications.
Matthew J. Finnegan, MD, is a Robotic General & Colorectal Surgeon with Shore Physicians Group specializing in robotic general surgery, colorectal surgery, and advanced surgical wound healing. He treats patients age 18 and older at 649 Shore Road in Somers Point. To schedule an appointment, call 609-365-6239.
