Medically reviewed by Patrick S. Wolf, M.D., F.A.C.S. • The Surgical Clinic
Diverticulitis is a common digestive condition that affects millions of Americans, especially as they age. While many cases can be managed with dietary changes, medications, and other non-surgical treatments, some people develop recurrent symptoms or serious complications that may require surgery.
So, how bad does diverticulitis have to get before surgery becomes necessary? In this article, The Surgical Clinic explains what diverticulitis is, how it differs from diverticulosis, the symptoms it can cause, and when surgical treatment may be recommended.
Understanding Diverticulitis
Before discussing when surgery may be necessary for diverticulitis, it helps to understand how diverticulitis develops and the symptoms it can cause.
What Are Diverticula?
Diverticula are small bulging pouches that develop in weak spots along the wall of the colon. They most commonly form in the lower portion of the colon and are thought to develop when pressure inside the colon pushes outward against these weakened areas.
Diverticula are more common with age. Other risk factors that may increase the likelihood of developing diverticula include obesity, physical inactivity, smoking, and a low-fiber diet.
Diverticulosis vs. Diverticulitis
Diverticulosis is the medical term for the presence of diverticula in the colon. Many people with diverticulosis have no symptoms and may not realize they have the condition until it is discovered during a colonoscopy or imaging study performed for another reason.
Being diagnosed with diverticulosis does not mean you have diverticulitis. In fact, many people with diverticulosis never develop acute diverticulitis.
Diverticulitis occurs when one or more diverticula become inflamed or infected. Unlike diverticulosis, diverticulitis can cause abdominal pain, fever, and other digestive symptoms and may lead to complications that require treatment.
In short, diverticula are pouches, diverticulosis means the pouches are present, and diverticulitis means the pouches have become inflamed or infected.
What Does Diverticulitis Feel Like?
People with diverticulitis most commonly experience abdominal pain, typically on the lower left side of the abdomen. The pain may develop suddenly or gradually worsen over several days.
Other symptoms of diverticulitis may include:
- Fever
- Nausea or vomiting
- Bloating
- Constipation
- Diarrhea
- Abdominal tenderness
Diverticulitis symptoms can vary widely. Most cases respond well to temporary diet modification and conservative non-surgical treatment, such as rest, fluids, and antibiotic treatment. Other times, more severe diverticulitis can lead to complications such as abscesses, perforations, fistulas, or bowel obstruction that may require hospitalization or surgery.
When Is Surgery Necessary for Diverticulitis?
Most people with diverticulitis do not require surgery. Most cases can be managed successfully with conservative diverticulitis treatment previously mentioned, including dietary modifications, medications when appropriate, and close monitoring by a healthcare provider.
However, surgery may be recommended when diverticulitis becomes severe, causes complications, or continues to recur despite treatment.
Severe or Complicated Diverticulitis
While many cases of diverticulitis are uncomplicated, some can progress and lead to serious complications that require surgical intervention.
Examples include:
- Abscesses, which are collections of infected fluid
- Perforations, or holes in the colon wall
- Fistulas, which are abnormal connections between organs
- Bowel obstructions that block the passage of stool
- Peritonitis, a potentially serious infection of the abdominal cavity
When these complications occur, surgery may be necessary to remove the affected portion of the colon and address the underlying problem.
Recurrent Diverticulitis
In the past, surgery was often recommended after a certain number of episodes of diverticulitis. Today, the decision is more individualized.
Some people experience repeated flare-ups that significantly affect their quality of life, require frequent hospitalizations, or make it difficult to work, travel, or participate in normal daily activities. In these situations, elective surgery may be considered even if a serious complication has not occurred.
Your surgeon will consider factors such as the frequency and severity of episodes, your overall health, and how the condition affects your daily life when determining whether surgery is appropriate.
What Is the Most Common Surgery for Diverticulitis?
The most common surgery for diverticulitis is a colectomy, also called a colon resection. During this procedure, a surgeon removes the diseased portion of the colon affected by diverticulitis and reconnects the healthy ends of the intestine.
In many cases, diverticulitis affects the sigmoid colon, which is the lower portion of the large intestine closest to the rectum. When this section is removed, the procedure may be referred to as a sigmoid colectomy.
Depending on the severity of the condition and the patient’s overall health, surgery may be performed using minimally invasive techniques, such as laparoscopic or robotic-assisted surgery.
These approaches use smaller incisions than traditional open surgery and may offer certain recovery benefits for some patients. Your surgeon will determine the most appropriate surgical approach based on your individual circumstances.
When Is Emergency Diverticulitis Surgery Needed?
Emergency surgery is uncommon but may be necessary when diverticulitis causes a perforation, widespread infection, or another complication that cannot be safely managed with non-surgical treatment. Because these situations can become serious quickly, prompt medical evaluation and treatment are essential.
Is Diverticulitis Surgery Worth It?
Diverticulitis surgery may be worth considering when the condition causes repeated flare-ups, serious complications, or ongoing symptoms that do not improve with non-surgical treatment.
However, surgery is not the right choice for everyone. A surgeon will consider your history, imaging results, overall health, risk of future complications, and how diverticulitis is affecting your daily life before recommending surgery.
Can You Live With Diverticulitis Without Surgery?
Yes. Most people with diverticulitis never require surgery and can manage the condition with medical treatment and ongoing monitoring. However, every case is different. If diverticulitis becomes recurrent, difficult to control, or leads to complications, surgery may offer the best long-term solution. The decision is highly individualized and should be made in consultation with an experienced surgeon.
When to Talk to a Surgeon About Diverticulitis
Most people with diverticulitis never require surgery. However, if you have experienced recurrent episodes, ongoing symptoms despite treatment, or complications related to diverticulitis, it may be time to discuss your options with a surgeon.
A surgical consultation does not mean surgery is inevitable. Instead, it provides an opportunity to review your symptoms, medical history, imaging results, and previous treatments to determine whether surgical intervention may be beneficial.
The Surgical Clinic: Expert Diverticulitis Surgeons in Middle Tennessee
At The Surgical Clinic, our experienced diverticulitis surgeons evaluate each patient individually and develop treatment recommendations based on the severity of diverticulitis, overall health, and long-term goals.
If you have questions about diverticulitis treatment or whether surgery may be appropriate, schedule a consultation with a surgeon at a TSC location near you to learn more about your options.