The Surgeons of The Surgical Clinic want everyone to know the signs and symptoms of a flare-up in your colon that is actually acute diverticulitis. Colonic diverticula are small herniations through points of weakness in the muscular wall of the colon, most commonly affecting the sigmoid colon. Acute diverticulitis is inflammation and infection resulting from the perforation of colonic diverticula. The most common symptoms of diverticulitis are left lower quadrant abdominal pain, fevers, chills, urinary urgency, and altered bowel habits. CT scan is the preferred diagnostic test for acute diverticulitis because it provides information on the severity of the disease and identifies complications.
Uncomplicated cases can often be treated with oral antibiotics on an outpatient basis. Focal peritonitis or systemic symptoms often indicate that hospitalization, intravenous antibiotics, and bowel rest are necessary. Patients who improve with antibiotics should be evaluated with a colonoscopy to exclude cancer which can mimic diverticulitis. The most common complication is a localized abscess, which can usually be treated successfully with percutaneous drainage and antibiotics. Diverticulitis is the most common cause of fistula between the colon and bladder. Severe cases with free perforation can present with generalized peritonitis requiring immediate operative intervention. In this situation, it is generally unsafe to restore intestinal continuity due to the increased risk of anastomotic leak. The appropriate surgical treatment in the emergent setting often requires the creation of a temporary colostomy or diverting ileostomy.
The chance of recurrent attacks after a second episode of diverticulitis is greater than 50% and increases with each episode. Surgical treatment with elective colon resection should generally be considered for patients with recurrent diverticulitis, or following recovery from complicated diverticulitis. Elective colon resection has a lower risk of morbidity compared to an urgent operation, generally avoids the need for a colostomy, and can usually be accomplished laparoscopically. Laparoscopic colon resection is associated with shorter hospitalization and more rapid recovery compared to open surgery. For more information, please contact one of our clinic locations if you have questions or concerns.