Treatment Protocols For Diverticulitis
Older patients suffering from diverticulitis may not even be concerned about the small gasps of air that interrupt the passage of urine, but younger patients are usually prompted to consult a physician. With an elderly patient complaining of vague urinary symptoms, ask if sputters and spurts occur at the start of urination, the way water comes through a garden hose when first turned on.
When a Diverticulitis Treatment abscess completes fistulization to the bladder, gas from the bowel as well as from the bladder, gas from the bowel as well as from the abscess may escape through the urethra. Any patient experiencing a fetid smell during urination will probably tell a doctor bout it; certainly he or she will remember the experience if asked.
A patient who reports having passed gas during urination for several weeks is not in need of immediate surgical evaluation. The inflammatory process has probably resolved, and elective surgery may be scheduled at the convenience of patient and surgeon.
If the patient reports having passed gas through the urine for the first time within the last few days, attention is more urgent. A 10-14 day course of a broad-spectrum antibiotic will stop the inflammatory process before further damage is done, and the patient can be readied for surgical correction. (See "First steps for acute diverticulitis," page 10, for more information on the antibiotic regimen.) A kidney, ureter, bladder film helps evaluate the possibility of a fistula. Gas leaking from an abscess under the diaphragm is a confirming sign. If surgery is necessary in a patient in whom bladder involvement is even suspected, cystoscopy is a must. Arrangements must be made to have a urologist standing by. Complications of diverticulitis that require immediate surgical intervention include persistent obstruction, perforation, and peritonitis. When the pain of presumed diverticulitis immobilizes the patient, immediate exploratory surgery becomes a major consideration. Even with a confirmed diagnosis of diverticulitis, the decision to operate may be controversial. The number of acute attacks over a given period may be a deciding factor. Although the specific cutoff point is somewhat arbitrary, three attacks within a year may be the criterion at one end of the spectrum, and six attacks over as many years may be the limit at the other end. A more reasonable approach takes into account the patient's age, condition, and activity outlook. For an otherwise healthy patient of age 30-40, surgery after recovery from the first attack may significantly lower the risk of later morbidity. Once diverticulitis has occurred, the likelihood of another inflammatory incident is significant, although the second attack may not occur for years. An elective procedure 2-3 months after the initial attack may save the patient from painful morbidity punctuating his or her life. On the other hand, in an elderly patient, surgery may be inadvisable even after several attacks. If a cardiac condition or some other systemic problem increases the surgical risk, it may be preferable to treat future attacks medically as they arise. Prompt antibiotic therapy may cause abscesses to resorb and prevent extended discomfort.
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