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Diverticulitis

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– My name is Dr. Ken Blake. I’m a colorectal surgeon at Sky Ridge Medical Center. Well, colorectal surgery offers a series of challenges in treating both benign and malignant diseases that can be life-threatening. There are several challenges. We endeavor to minimize the number of colostomies we make. The functional considerations of colorectal surgery in terms of people having normal dietary, normal bowel function, normal control of their feces is important and very challenging and much more prevalent than people usually believe. Well, diverticulitis generally presents as abdominal pain, most frequently in the left lower quadrant. The pain will often be crampy. There may be associated fevers and chills. There may be a sense of urinary urgency, frequency. The bowel cramps may alleviate with bowel movements. These symptoms can come on very suddenly. About 1% of the episodes of diverticulitis are what I would describe as catastrophic, where there is massive contamination of the abdominal cavity. These patients will have a difficult time getting out of bed. They will have high fevers and chills. These are surgical emergencies that need to go to the operating room really immediately.

Another set of patients will have smoldering symptoms that are chronic. They’ll have periodic abdominal pain, cramps, and these patients also need to be evaluated, because these symptoms may indicate a serious, life-threatening condition like colorectal cancer. But even if it is just diverticulitis, these patients are burdened. They lose days of work. They don’t engage in their recreational and family activities, and it’s an important diagnosis for us to make, which is most commonly and reliably made by an abdominal pelvic CAT scan. Well simple diverticulitis can be treated with oral antibiotics that may be provided by your family physician or an urgent care center or the emergency room. My definition of simple diverticulitis is an episode which resolves is about 72 hours. If it persists or if the patient has protracted nausea, vomiting or cannot get out of bed or cannot keep food down, or if there’s blood in the stool, then that requires prompt, urgent evaluation.

The treatment again at that phase will likely be antibiotics, as one of the surgical principles in treating diverticulitis is to avoid urgent surgery or emergent surgery. When we operate urgently or emergently, our ostomy rate, we need to make ileostomies or colostomies much more frequently. If we can settle the patient down, and that may require inpatient hospitalization, or we can give antibiotics on the outpatient basis using a PICC line, we try to settle the inflammation down. Then, the patient will need a colonoscopy to make sure we are not dealing with a malignancy. And then, if the patient keeps having recurrent attacks or what I refer to as smoldering diverticulitis, then surgery will likely be indicated if the patient remains symptomatic to alleviate their pain and to permit them to return to full occupational, recreational and family life.

And then, we can do this surgery with minimally-invasive techniques, either with the laparoscope or the robot. We average about a three to four day length in stay, and when we operate electively, as opposed to emergently, our colostomy, ileostomy rate is well less than 2%. So, the recovery process from surgery for diverticular disease does impose about a four to six week limit on any weightlifting. The patients, after they’re discharged, I encourage them to walk. They can do after two weeks I let my patients get on a treadmill or an elliptical or a StairMaster, but I do not want them lifting any weights for six weeks. There’s a gradual reintroduction of completely normal foods. There is no long-term dietary restriction, and for most patients, there are no long-term implications with regards to bowel function diet..

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