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Diverticulitis
Diverticulitis
occurs in people with diverticulosis. It most
commonly affects the sigmoid colon, which is the
last part of the large intestine just before the
rectum. Diverticulitis is more common in people
older than 40. It can be severe in people of any
age, although it is most serious in the elderly,
especially those taking corticosteroids or other
drugs that suppress the immune system and thus
increase the hazards of infection.
Treatment
In general, your treatment depends on the severity of
your symptoms and whether this is your first attack of diverticulitis.
If your symptoms are mild, a liquid or low-fiber diet and antibiotics
may be all you need. But if you're at risk of complications or have
recurrent attacks of diverticulitis, you may need more advanced care.
Home
care
If your condition calls for home treatment, expect to
remain quiet for a few days. You'll also temporarily need to avoid all
whole grains, fruits and vegetables, so your colon can rest and heal.
Once your symptoms improve — often in two to four days — you can
gradually start increasing the amount of high-fiber foods in your diet.
In addition, your doctor will likely prescribe
antibiotics to help kill the bacteria causing your infection. Even if
you start feeling better, be sure to finish your entire course of
medication. Stopping too soon could cause your infection to come back.
It also helps create strains of bacteria that are resistant to
antibiotics. If you have moderate or severe pain, your doctor may
recommend an over-the-counter pain reliever such as acetaminophen
(Tylenol, others) or a prescription pain medication, although these
medications tend to be constipating and may aggravate the problem.
Hospitalization
About half the people with diverticulitis require
hospitalization and many need intravenous antibiotics. You're more
likely to be hospitalized if you have vomiting, a fever above 39 C, a
high white blood cell count or are at risk of complications such as a
bowel obstruction or peritonitis. You're also likely to need additional
care if you are older, have another disease or have a weakened immune
system.
Surgery
If you have recurring diverticulitis, your doctor may
recommend surgery to remove the diseased part of your colon. There are
two types of surgery:
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Primary bowel resection.
This is the standard surgery for people with diverticulitis. Your
surgeon will remove the diseased part of your intestine and then
reconnect the healthy segments of your colon (anastomosis). This
allows you to have normal bowel movements. Depending on the amount
of inflammation, you may have open (traditional) or laparoscopic
surgery. In open surgery, your surgeon makes one long incision in
your abdomen, while laparoscopic surgery is performed through three
or four tiny incisions. You'll heal faster and recover more quickly
with laparoscopic surgery. Unfortunately, it may not be an option if
you are very overweight or have extensive inflammation.
-
Bowel resection with colostomy.
This surgery may be necessary if you have so much inflammation in
your colon that it's not possible to rejoin your colon and rectum.
During a colostomy, your surgeon makes an opening (stoma) in your
abdominal wall. The unaffected part of your colon is then connected
to the stoma, and waste passes through the opening into a bag. A
colostomy may be temporary or permanent. Several months later — once
the inflammation has healed — your surgeon may be able to perform a
second operation to reconnect your colon and rectum.
Diverticulitis
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