Internal Medicine

Diverticulitis Surgery - What Are the Dangers?

Conservative therapy should always be exhausted before an operation

If the presence of bulges in the intestinal wall is known (Diverticulosis) should Eaten high in fiber become, drank a lot and yourself moved a lot become. Otherwise no further therapy is required Diverticulitis.

Diet and Antibiotics

If the diverticula are inflamed, either conservative or surgical treatment can be used. Treatment is conservative in the case of extremely acute or mild inflammation.

If the inflammation is severe, the patient should be hospitalized for possible surgery. He is not allowed to eat (nutrition via the blood by infusion) and is administered with a Broad spectrum antibiotic treated.
If pus has accumulated, it must be drained. Pain medication and those that reduce the tension in the intestinal muscles are also administered.

Even if the inflammation is mild, it will be antibiotic treated. However, the treatment is usually carried out on an outpatient basis, i.e. at home.

Read everything under the topics:

Antibiotics for diverticulitis
Diet in a diverticulum

How long are you sick after an operation?

The acute inflammation of a sacs in the intestinal wall, i.e. a diverticulum, usually requires an operation quickly to prevent the inflamed material from spreading further in the abdomen.

This is often done these days laparoscopic proceeded, that is, only a few small incisions are made on the abdominal wall, through which the surgical instruments are inserted under the camera view. If this surgical technique is used, it is Recovery usually faster and that is usually limited Hospital stay on about ten daysprovided there are no further complications. After that, patients are mostly on sick leave for another two to three weeksbefore they can go back to their usual job. However, this information relates to an uncomplicated course in which everything goes as planned and the patient no longer has any pain or discomfort after this time.

Indication for surgery

Diverticula are only operated on to avoid the complications of the Diverticulosis or to correct or generally avoid diverticulitis. A surgical procedure is therefore less than 5% the diverticulum carrier necessary. Remains with a diverticulitis flare-up 24-48 hours conservative therapy If there is improvement, an operation can be decided depending on the patient's condition. This should be carried out promptly, but not as an emergency operation.

If there are repeated attacks of inflammation, but at the earliest after second thrust, an operation is possible in one non-inflammatory state conceivable. The same applies to the case of one Narrowing (obstruction) of the inflamed bowel loop without completely obstructing the intestinal passage. With a complete Intestinal obstruction or one Intestinal perforation due to a ruptured diverticulum (perforation), immediate surgery is essential.

The inflammation in diverticula can lead to bleeding of the large intestine, which can be expressed as blood draining through the anus. Depending on the extent of the bleeding, this is also a sign that justifies an intervention. The urgency of the operation depends on the severity of the bleeding. However, there is an 80% probability that the sources of bleeding will close without intervention.

surgery

An operation for diverticulitis is necessary immediately if an inflamed diverticulum ruptures and the inflammation spreads into the abdominal cavity. Bleeding, constipation, fistula formation or frequent relapses also make an operation necessary.

Either the section of the intestine is removed during the operation and the two remaining ends sewn together, or an artificial anus is temporarily created. The artificial anus is usually placed after an emergency operation because of the strong inflammatory reaction. The inflammation can now subside and after about eight to twelve weeks the anus praeter is moved back.

There are two surgical procedures.
The surgical interventions (operation) can be done either with an abdominal incision or a laparoscopy. The abdominal incision is a conventional operation in which the abdominal cavity is opened. During the laparoscopy (Laprascopy) on the other hand, a small incision is made in the area of the belly button. Now the belly is inflated with carbonic acid gas.
An optical device is inserted through the navel (Laprascope) with which you can get a glimpse of the abdominal cavity through a mini camera. Further instruments are introduced into the abdominal cavity through further tiny incisions. The affected large intestine is now removed under sight.

Read more on the subject at: Remove colon

Duration of the operation

The duration of the diverticulitis surgery depends on the selected surgical technique, the circumstances on the patient (pre-operated, obese etc.) and the severity of the disease. As a rule and without any special features, a duration of approx. 1-3 hours realistic for the operating room.

Hansen and Stock stages

The Classification of the disease stages The diverticulitis is not mandatory, however the Classification according to Hansen and Stock proven in everyday clinical practice. Here will be 4 stages, i.e. the severity of the disease, including the precise designation of the stage of the disease and the respective clinical complaints.

The Stage 0 is referred to as uncomplicated diverticulosis, so one inflammation-free colon change with small bulges in the intestinal wall (diverticula). In the Diverticulosis are mostly found no symptoms of illness.
The so-called acute, uncomplicated diverticulitis represents that 1st stage Here the inflammation can only be determined on the intestinal wall. Clinically can Pain in the lower abdomen such as fever occur.
The 2nd stage is called acute, complicated diverticulitis designated. This stage will vary depending on Degree of spread of the inflammation in the intestinal wall still in 3 sub-categories (IIa, IIb, IIc). It comes to one Intestinal perforation (perforation) the intestinal wall in the area of the protrusions (diverticula), this is one Emergency situation, as through leaking intestinal germs the whole abdomen can inflame (Peritonitis). This clinical picture is clinically called acute abdomen (Acute abdomen) designated. A rapid surgical intervention should help prevent inflammation from spreading Stage IIc respectively.
The final stage (Stage III) forms the chronic, recurring form diverticulitis (chronic recurrent diverticulitis). This stage is characterized by recurrent (recurrent) pelvic pain, such as constipation (Constipation). The clinical picture of a incomplete intestinal obstruction with very slow food transport (Subileus) occur.

Learn more about the Stages of diverticulitis.

Preparation for the operation

As with all operations, a previous one is required enlightenment carried out by a surgeon, where the surgical technique and open questions should be discussed. In most cases of uncomplicated diverticulitis, surgery is done minimally invasive by means of Keyhole technology. In addition to the presentation to the anesthetist to discuss the anesthesia - mostly in the case of intestinal surgery general anesthetic with spinal cord anesthesia - a blood test will take place in preparation for each operation. Typically, diverticulitis shows up Increase in white blood cells (Leukocytosis) and an increase in Inflammation values (CRP). In addition, the ability of the blood to clot must be known in order to keep the risk of bleeding as low as possible.

In the case of a planned operation, patients who regularly take medication should speak to their general practitioner or the operating doctor in good time about the need for certain medications, for example Marcumarto discontinue or replace before surgery. Before the operation is carried out, of course, a diagnosis must be carried out in which the disease can be defined as clearly as possible. The diverticula themselves are usually about the Colon contrast examination proven. You can also use it Wound ducts (Fistulas) and Constrictions being represented. The Abdominal voiding (roentgen), as well as the Computed Tomography (CT) and Sonography serve to rule out further complications if they are suspected. For bleeding is one Colonoscopy (Colonoscopy) rarely helpful. Vascular imaging by means of X-ray (selective angiography) or computed tomography (CT angiography) preferably to find the source of the bleeding.

In the event of a life-threatening bleeding, a free intestinal perforation or an acute intestinal obstruction, only the most necessary preparations can be made and a Emergency intervention occur.

In order to avoid the contamination of the abdominal cavity with stool, a laxative and Intestinal cleansing drinking solutione.g. Delco Prep, taken. Except for clear broth, the patient should not consume anything other than the drinking solution on that day. From midnight on the day of the operation, the patient should be complete sober stay and possibly no more smoke. After consultation, necessary long-term medication can be taken with a small sip of water on the morning of the operation. The patient should use the early morning time before the surgery to shower. This is usually also the point in time at which any hair on the stomach with a Disposable razors is removed by the nurse, the surgeon or, as instructed, by the patient himself.

Complications

Most critical to the success of the operation is that quality the end-to-end connection of the two ends of the intestine, from the middle of which a piece has been removed. Is the seam leakyso the abdominal cavity of bacterial stool become dirty and cause severe inflammation. Such inflammation can be confined to one location in the abdominal cavity or it can spread throughout the abdomen. A Peritonitis (Peritonitis) can be fatal under certain circumstances.

Abscesses (pus-filled capsule) can, like after a perforation (Perforation) of the intestine, caused by contamination of the abdominal cavity. They are usually felt as a painful hardening in the lower abdomen with a persistent increase in body temperature and chills.

Fistulous ducts (tubular connections) can be left behind after the operation.They form a passage from the operated bowel to adjacent organs or the outer edge of the wound (skin). They arise because of a incomplete Scarringwhich means the tissue does not grow together properly and leaves behind Wound cavity. A small hole can often be seen in the area of the surgical incision, from which stool or secretion is running. In the case of a fistula formation with the urinary bladder, recurrent ones often develop Urinary tract infections. Admixtures of air in the urine (Pneumaturia) or the mixing of urine with bowel movements (Fecaluria) can be signs of such a fistula formation. In 30%, however, the fistulas remain undetected due to the minor or nonexistent symptoms.

Scarring naturally occurs in the abdomen after an operation, which is not externally visible to us. As a result of this scarring it can too Narrowing of the intestinal lumen and in the worst case to Intestinal obstruction (Bridenileus) come.

If nerve plexuses are damaged during the operation, this can lead to stool and / or Urinary incontinence or in rare cases too Erectile dysfunction lead with men.

Other unspecific complications include the Injury to blood vessels with a blood loss in which one Blood transfusion An infection of the outer skin / wound edges or the Injury to other abdominal organs such as. of the bladder or healthy intestinal sections.

Consequences of the operation

After a successful operation is a diverticulosis patient not cured. Most diverticula are already present in several places in the intestine, so that not all of them are removed during the operation. As before, the affected person tends to develop new diverticula in the intestine and can develop diverticulitis, which may have to be operated on repeatedly. After a complication-free procedure, no noticeable consequences for the patient are to be expected if a relatively small section of the colon is removed. Multiple resections and the removal of large sections of the colon increase the chance of one complication (see above). The shorter the colon, the worse it is for water from bowel movements back into the passage during the passage Body circulation and the more mushy the excreted stool becomes.

If the intestine was perforated and the abdominal cavity was contaminated, a artificial anus (Colostomy) be attached (Hartmann operation). This artificial anus requires special care and a certain amount of training for the patient. These patients are only slightly restricted in their everyday activities, but often forego contact with other people, as unplanned emptying of their stool into the bag appears embarrassing and annoying to them. If the two ends of the intestine can be connected to each other again after the course has gone without complications, the patient will have normal bowel evacuation as before the operation. Usually only a scar remains from the artificial anus.

As a rule, the patient can return after approx. 7 days leave the hospital again. In order not to strain the wound edges is first physical conservation to recommend. The outer ones Skin sutures are according to wound healing 10-14 days away. The threads in the abdominal cavity and intestines are self-dissolving and thus remain in the body.
It is important to refrain from certain food recommended for all patients even after diverticulitis surgery. Since they still have diverticula, they should eat according to the recommendations in order to contain new flare-ups as far as possible.