Colonic diverticula are small pouches protruding from the colon that form over time. As we age, we are more likely to have this condition called diverticulosis. Approximately half of all adults over age 60 have diverticula. Diverticulosis is normally diagnosed at the time of screening colonoscopy and you likely will be advised to start a high fiber diet. The prevalence of diverticula has increased as our dietary fiber has decreased.
Similar to how people develop appendicitis and even ruptured appendicitis, the same can occur with diverticula. This is called diverticulitis. This may be mild and treated outpatient with oral antibiotics or in the hospital with intravenous antibiotics.
Perforated diverticulitis can also result in leaking pus or stool into the abdominal cavity. This may result in an abscess or sepsis. This can be life threatening and depending on the severity, may require emergent surgery. Unfortunately, emergent surgery for perforated diverticulitis can result in a colostomy. A colostomy means that the colon is brought through the skin on the abdominal wall to collect stool in an external bag. This is often temporary and can be reversed, but may be permanent in some situations.
Even if the colon heals, sometimes scar tissue can form a narrowing called a stricture. Colonic strictures often cause symptoms and often require surgery. Even after you heal from an episode of diverticulitis, a colonoscopy may be required to rule out stricture and cancer.
Diverticula may be diagnosed incidentally on screening colonoscopy when not causing symptoms. Diverticulitis is often diagnosed with computed tomography or CT scan. when it causes symptoms. CT scan is helpful in identifying signs of perforation, the severity of disease, and other signs such as an abscess or colonic mass.
Surgery involves removing the affected portion of the colon or as much of it as possible. This is almost always the portion of the colon called the sigmoid colon. Sometimes diverticula are extensive and involving most of the colon. While it is not always possible to remove all the diverticula, removing the sigmoid colon dramatically reduces the chance of having diverticulitis again. Ideally surgery is performed while the colon is not actively inflamed during an episode of diverticulitis.
In my hands, the vast majority patients with elective or emergent colon surgery for diverticulitis can be performed laparoscopically or using robotic surgery. These types of minimally invasive surgery reduce the rate of complications such as hernias, bowel obstructions from adhesions, and wound infections.
Colonic surgery requires an overnight hospital stay and patients typically go home on the second or third day after surgery. Occasionally some patients stay longer waiting on the gastrointestinal tract to function again. Most patients return to light duty work in a couple of weeks and full activity by four weeks.