Is Surgery Advisable For Diverticulitis?
Hospitalization is warranted in patients who seem unreliable in terms of returning for follow-up care, and in complicated diverticulitis, which occurs in up to 20% of cases. Complications include perforation abscess, fistula, stricture, and obstruction. Patients who are immuno-comprised, have diabetes, take steroids, are on chemotherapy are post transplant, are HIV infected, or have renal failure also should be admitted.
Emergently ill patients, such as those with diffuse peritonitis, should be sent for surgery. Other hospitalized patients who don't respond to non-surgical treatment should also be sent for surgery.
Patients treated on an outpatient basis who respond to therapy generally don' need elective surgery especially if they are over age 50. A surgical referral should be considered after a second episode, which increases the average recurrence rate to 50% instead of 30%.
Patients who don't get well on antibiotics, those who develop complications, an young patients who have even one episode of diverticulitis should also be referred for surgical evaluation, he added. Only about 5% of diverticulitis cases occur in people under age 40, but half of those cases involve complications such as abscesses or perforations. Literature from the 1990s and 2000s suggested that the recurrence rate in younger patients exceeded 50%, suggesting that surgery should be considered in all patients younger than 40 who have even a first episode of diverticulitis. More recent studies suggest that the recurrence rate is closer to 20% or 30%. Diverticulitis in young adults clearly is a different disease than diverticulitis in older people. There must be some predisposition, a congenital weakness of the wall or something genetically that predisposes them". Whether Diverticulitis surgery should be considered in this age group after the first episode is controversial. A mild episode can be managed medically and watched closely, but a patient with recurrences should be referred for surgical evaluation. Diverticulosis is a product of our modern society, our diet, and our hurried lifestyle. Since the invention of the refining process that removed naturally occurring fiber from wheat and sugar at the turn of the century, the incidence of diverticulosis has been steadily increasing. In the United States, it is estimated that 30 million people have this problem. Diverticulosis may occur in any location in the intestine, but is most commonly located near the end portion of the large bowel. The condition occurs when the inner lining of the bowel pushes through the outer wall. These protruding inner layers create little pockets of the bowel, typically at areas in the bowel where there are points of weakness. The pockets are the diverticulae and the condition is called diverticulitis. It is believed that because of our refined diet and our time-constrained lifestyle, the stools are firmer and smaller. This requires more straining and higher pressures within the bowel in order to have a bowel movement. These higher pressures cause these pockets to form. The process occurs over a period of many years and diverticulosis is more often seen after the age of 50. The condition is painless, and 80 percent of the people with diverticulosis never have any problems. Complications, however, can occur, the most common of which is when these diverticulae become inflamed and infected, a condition called diverticulitis. This causes abdominal pain, occasionally a fever, and may cause either constipation or diarrhea. Other complications, less commonly seen, include bleeding, abscess formation, and intestinal obstruction. Treatment of these conditions usually requires antibiotics. Sometimes surgery becomes necessary, especially if the diverticulae rupture or if the bleeding is severe.
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