Sigmoid Diverticulitis
Diagnostics
In most cases a single diverticulitis doesn't cause any pain. However, rests of stool can cause recurrent infections with pain in the left hypogastric region as well as constipation, fever and nausea.
A diverticulitis is diagnosed by an increase of the inflammatory factors which are analyzed during a blood examination, and the proof of the diverticulum in a CT (with contrast medium) or in a contast study of the colon. A coloscopy should always be performed during an inflammation-free interval to exclude the existence of tumors.
Surgery
A laparoscopic partial resection of the colon is indicated after two or more attacks of a sigmoid diverticulitis. The Deutsche Gesellschaft für Chirugie (German Society for Surgery) recommends surgery for patients younger than age 50 even already after the first attack of an infalmmation.
The initial treatment consists of a reduced intake of food and an antibiotic therapy until the patient is back to normal temperature. If possible surgery should be performed during an inflammatory-free interval.
Complications of a sigmoid diverticulitis like intestinal perforation and intestinal obstruction (ileus) are causes for an immediate emergency operation.
Surgical Risks
The visualization of the urinary duct prevents its violation during surgery. The risk of a wound infection is 2-6 % in our case material.
The main risk of this operation is a permeability of the intestinal suture (anastomosis insufficiency) which is much higher with emergency operation than with a planned or laparoscopic one. In our case material the risk is about 2%. After the resection of an inflammated or burst part of the colon it is sometimes necessary to attach an artificial anus and a colostomy bag into which the feces will be drained for a certain time, and which will be removed after several weeks or months.
Special Questions
- After surgery an early well-balanced nourishment will follow according to the so-called "Fast Track" scheme. This includes, apart from early nourishment , a special pain therapy and early mobilization. Drains from the abdominal cavity and the bladder will be removed early.
- A laparoscopic operation is usually performed with three small incisions and one 5cm long incicion. The general method requires a lower abdominal incision up to and around the belly button.
- If surgery is planned your stay in hospital will take 7-10 days. 1-2 weeks of rest without physical exertion are recommended.
- Surgery and anesthesia with a passing immobilization of the peristalsis will cause a sense of fullness in the abdomen combined with winds, which can last up to 2-3 weeks. During that time certain maesures to keep the stool soft should be administered.
