Treatment of Diverticular
Disease and Diverticulitis

Diverticula of the colon are very common in western countries and we talk about a diverticulosis when many such diverticula are present in the colon. However, as long as these diverticula do not cause any symptoms, they usually do not require any treatment. Eighty percent of individuals who have diverticula of their colon never develop symptoms. Only if diverticula become symptomatic we are talking about “diverticular disease”.

When diverticula of the colon become inflamed, we are talking about a “diverticulitis”, that can be associated with severe abdominal pain and might entail dangerous complications, such as abscess formation or perforation. In these causes emergency surgery might be necessary.

If you suffer from symptoms from diverticula, please do not hesitate to contact us. We are happy to discuss the situation and potential treatment options with you.

Make an appointment now

Examination for and Treatment of Diverticulitis

Symptoms such as lower abdominal pain, fever, changes of bowel habits, etc. might be caused by diverticulitis. To identify the cause of this symptoms, further investigations might be necessary. The palpation of the abdomen might reveal pain and hardening in the lower abdomen. Inflammatory signs might be elevated in blood tests. Imaging by ultrasound or CT scan can help to identify the extent of the inflammation. Colonoscopy is usually not indicated during the phase of an acute inflammation.

The treatment depends in large part on the stage of the disease. While simple and localized inflammation can in most cases be successfully treated by bowel rest and medication, severe and complicated disease e.g. entailing abscesses, fistulas or perforation, usually requires surgical treatment and in some cases even emergency surgery.

Frequently Asked Questions Concerning Diverticular Disease

How do diverticula develop?

Ninety percent of colonic diverticula are located in the last, S-shaped part of the colon, the so-called sigmoid colon. Different to other parts of the intestine, the architecture of the wall of the sigmoid colon shows small gaps for blood vessels in the muscle layer, that allow diverticula to develop and are the reason why the majority of diverticula are found in the sigmoid colon and not in other parts of the colon.

Who develops diverticula?

The older people get, the more likely they are to develop diverticula with people beyond the age of 70, carrying diverticula in more that 50% of the cases. However, we observe a growing number of young people who develop not only diverticula, but also complications of these diverticula such as diverticulitis. Factors promoting the development of diverticula are obesity, low-carb diet, lack of exercise, etc., and these circumstances are becoming more and more common in our society.

Are diverticula a disease?

The sole presence of diverticula, that are frequently identified during colonoscopies, is not a disease and we are only talking of a “diverticulosis” as long as diverticula are not causing any symptoms. However, these diverticula do not go away anymore and can eventually cause symptoms. If this happens, we are talking about “diverticular disease”. To avoid their development and to reduce the risk of diverticula becoming symptomatic, individuals should eat a high-fiber diet, exercise frequently, and keep their body weight in the normal range. This also helps to prevent the development of other diseases such as colorectal cancer, hypertension, and diabetes, etc…

What problems can diverticula cause?

While many people carry diverticula in their sigmoid colon, only 10-15% of these individuals develop symptoms over time. The most common problem that occurs, is an inflammation of one or several diverticula and the adjacent piece of the colon. This inflammation can extend into the surrounding of the colon and the extent and degree of this inflammation usually determines the necessary treatment.
Recurrent and even minor inflammation can cause a scaring of the bowel leading to a narrowing and stenosis of the bowel lumen, that can hamper to passage of stool through the bowel and lead to obstruction and constipation. If medical regulation of bowel movements fails, surgical intervention might be indicated.

As diverticula protrude through small gaps in the muscular layer of the colon, through which also blood vessels find their way through the bowel wall, diverticula can also cause severe bleedings, with significant perianal loss of blood. If such a bleeding cannot be stopped during endoscopy, surgery might be required in rare case.

How does a diverticulitis present?

The complaints usually depend on the degree of inflammation. As the sigmoid colon is located in the left lower quadrant of the abdomen, this is where the pain most frequently occurs. Most patients also report of fever or shivering and some patients observe changes in their bowel habits that can be obstipation as well as diarrhea. When diverticula rupture, a perforation can occur with stool and bacteria getting into the abdominal cavity leading to the development of a so-called peritonitis that is usually accompanied by massive and diffuse abdominal pain, fever, and sickness and that requires immediate presentation to a hospital followed by surgical intervention.

Do all patients with diverticulitis have to undergo surgery?

While one or two decades ago patients with diverticulitis were usually operated after the first or second attack, we nowadays become much more reluctant with the indication for surgery for the treatment of diverticulitis. The reason is, that we learned that not all patients who develop one or two uncomplicated attacks of a diverticulitis, also develop further attacks, but that a large proportion of these patients will not experience further attacks during the rest of their lives. Furthermore, in contrast to the general thinking, it has been demonstrated, that the risk of severe complications such as a free perforation of the bowel with peritonitis and the need for emergency surgery, appears not to increase but rather to decrease with the number attacks, as long as these are so-called “uncomplicated attacks”. Therefore, nowadays, the indication for patients to undergo surgery for recurrent diverticulitis, is in most cases not based on the number of attacks patients develop, but rather on the degree of inflammation and on how much patients suffer from the disease.

The recent guideline for the treatment of diverticulitis distinguishes between “uncomplicated” and “complicated” disease. The inflammation is limited to the bowel wall in patients with “uncomplicated” diverticulitis. This situation can usually be successfully treated with bowel rest, pain medication, and antibiotics and rarely requires surgical intervention. In contrast, “complicated” diverticulitis is usually associated with a at least temporary leak of the bowel wall, leading to a spill of bacteria into the surrounding of the bowel, that can lead to abscess formation or peritonitis. In these cases, surgery should be considered. In patients with a localized abscess it can be useful to drain the abscess, e.g. by a CT-guided drainage, and to minimize the inflammation by the use of antibiotics before undergoing resection of the affected piece of colon. Differently, emergency surgery is necessary in cases with free perforation and peritonitis that can lead to a life-threatening situation.

What shall I do if I suffer from recurrent attacks of a diverticulitis?

The quality of life of patients who suffer from recurrent attacks of a diverticulitis, leading to pain, use of antibiotics, sick leave, and admission to a hospital can be seriously impaired and patients often suffer from the insecurity when they are planning their private and work life. In these cases, surgery can be considered on an individual basis balancing the restrictions patients experience due to the disease against the relatively low risk of the surgical procedure. This is particularly the case when patients do not respond to medical treatment anymore and the symptom-free intervals become shorter and shorter. We are glad to give you our advice in this difficult situation.

How is the surgical procedure performed?

During surgery, not only the inflamed diverticula are removed. In fact, the operation comprises the removal of the entire sigmoid colon, as due to the anatomical properties of this piece of bowel, this entire segment has to be removed to prevent the recurrence of the disease later on after the operation. The procedure is usually carried out by minimal invasive, laparoscopic surgery with a discharge about five to seven days after the operation.

„We do whatever it needs to make you healthy again.“
Your health is our primary concern.
„We do whatever it needs to make you healthy again.“
Your health is our primary concern.

We are a team of highly qualified surgeons with long surgical experience working with state-of-the-art techniques.

Our Surgeons
Make an appointment
© Chirurgie Josephinum 2019 | twin Werbeagentur GmbH
Termin online buchen
Verwendung von Cookies
Wir nutzen Cookies auf unserer Website. Einige von ihnen sind notwendig während andere uns helfen, diese Website und Ihre Erfahrung zu verbessern. Sie akzeptieren unsere Cookies, wenn Sie fortfahren diese Webseite zu nutzen.

Impressum Datenschutzerklärung
Cookie-Einstellungen
Hier finden Sie eine Übersicht über alle verwendeten Cookies und Skripte. Sie haben die Möglichkeit folgende Kategorien zu akzeptieren oder zu blockieren.
Immer akzeptieren
Notwendige Cookies sind für die ordnungsgemäße Funktion der Website erforderlich. Diese Kategorie enthält nur Cookies, die grundlegende Funktionen und Sicherheitsmerkmale der Website gewährleisten. Diese Cookies speichern keine persönlichen Informationen.
NameBeschreibung
bypass
Dieses Cookie wird für den Wartungsmodus verwendet.
Anbieter - Typ Cookie Laufzeit 1 Jahr
PHPSESSID
Dieses Cookie ist für PHP-Anwendungen. Das Cookie wird verwendet um die eindeutige Session-ID eines Benutzers zu speichern und zu identifizieren um die Benutzersitzung auf der Website zu verwalten. Das Cookie ist ein Session-Cookie und wird gelöscht, wenn alle Browser-Fenster geschlossen werden.
Anbieter - Typ Cookie Laufzeit Session
Analytische Cookies werden verwendet, um zu verstehen, wie Besucher mit der Website interagieren. Diese Cookies helfen bei der Bereitstellung von Informationen zu Metriken wie Besucherzahl, Absprungrate, Ursprung oder ähnlichem.
NameBeschreibung
Performance Cookies sammeln Informationen darüber, wie Besucher eine Webseite nutzen. Beispielsweise welche Seiten Besucher wie häufig und wie lange besuchen, die Ladezeit der Website oder ob der Besucher Fehlermeldungen angezeigt bekommen. Alle Informationen, die diese Cookies sammeln, sind zusammengefasst und anonym - sie können keinen Besucher identifizieren.
NameBeschreibung
_ga
Dieses Cookie wird von Google Analytics installiert. Dieses Cookie wird verwendet um Besucher-, Sitzungs- und Kampagnendaten zu berechnen und die Nutzung der Website für einen Analysebericht zu erfassen. Die Cookies speichern diese Informationen anonym und weisen eine zufällig generierte Nummer Besuchern zu um sie eindeutig zu identifizieren.
Anbieter Google Inc. Typ Cookie Laufzeit 2 Jahre
_gid
Dieses Cookie wird von Google Analytics installiert. Das Cookie wird verwendet, um Informationen darüber zu speichern, wie Besucher eine Website nutzen und hilft bei der Erstellung eines Analyseberichts über den Zustand der Website. Die gesammelten Daten umfassen in anonymisierter Form die Anzahl der Besucher, die Website von der sie gekommen sind und die besuchten Seiten.
Anbieter Google Inc. Typ Cookie Laufzeit 24 Stunden
Marketing Cookies werden für Werbung verwendet, um Besuchern relevante Anzeigen und Marketingkampagnen bereitzustellen. Diese Cookies verfolgen Besucher auf verschiedenen Websites und sammeln Informationen, um angepasste Anzeigen bereitzustellen.
NameBeschreibung
NID
Google verwendet Cookies wie das NID-Cookie, um Werbung in Google-Produkten wie der Google-Suche individuell anzupassen.
Anbieter Google Inc. Typ Cookie Laufzeit 24 Stunden
SID
Google verwendet Cookies wie das SID-Cookie, um Werbung in Google-Produkten wie der Google-Suche individuell anzupassen.
Anbieter Google Inc. Typ Cookie Laufzeit 24 Stunden
Sonstige Cookies müssen noch analysiert werden und wurden noch in keiner Kategorie eingestuft.
NameBeschreibung

Zurück