Digestive Disorders / Gastroenterology Expert Forum
When is surgery necessary for diverticulitis?
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When is surgery necessary for diverticulitis?

When at what point is surgery recommended for diverticulitis? See history below.

In May of 2002 I had an extremely bad first attack of diverticulitis resulting in a trip to the ER. I have been under the care of a gastro doctor since. I have had all the usual fun tests-colonscopy, etc. which showed moderate diverticulosis. I had a second mild attack in August 2006 and now my third very mild attack this week. I am on antibotics. I have never had any bleeding issues with the attacks-just pain and tenderness ,except for the first attack when I thought I was having another baby. :)

I have always eaten a diet high in fiber, fresh fruits , veggies,organics, etc. I usually do not eat fast food or fried greasy food. I know which foods bother me and do not eat them ( sauerkraut).  This week is hard on me because I usually do not eat noodles, rice and high carb items. My family history ( brother ) includes issues with ployps.

I am overweight, but the only meds I take are protonix PRN. I have been on an excersise program to lose the extra weight, but have stopped for now because of the localized pain.

My GI doctor keeps recommeneding surgery, but I think three incidents in 6 years does not require surgery. Plus everything I read about the surgery is not encouraging. Additionally I have been reading that only 8% need the surgery and lap surgery may now be an option and that people have issues with diverticulitis even after surgery.

I am thinking the doctors are cut happy. I would like to get a second opinion.I live close to Carolina, Duke and Wake Forest Med schools.

Thank You

Worried in NC
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233190_tn?1278553401
I agree with another opinion.

There are no clear guidelines to recommend surgery, however I generally send people off for a surgeon if they have more than 1 occurrence in a given year.  

Different physicians may have lower or higher thresholds for referral.

A second opinion is always a good idea in borderline cases.

This answer is not intended as and does not substitute for medical advice - the information presented is for patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com
5 Comments
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Avatar_m_tn
Hi - I underwent a total colectomy four years ago - but in my case I had developed sudden torrential rectal bleeding which, after the usual tests, demonstrated diverticular disease.  Due to continuing low blood count and also a further episode of less severe bleeding, the recommendation was suggested by my surgeon that I undergo a total colectomy.  I believe that this was somewhat of a (correct) defensive measure because, otherwise, there would exist the ever-present risk of further bleeding (which can be life-threatening) - and this could occur when I was not near an emergency hospital department.  So much for the history book....!!

From your point of view, I guess that you must weigh up - and seek professional advice- as to whether there is a significant risk that severe bleeding could eventuate in your case.  Also whether the present treatment regime of "occasional suffering with antibiotics" is tolerable.

Now, my surgery was "surgeon's hands inside the abdomen" (i.e. not laparascopic).  I was fortunate and did not require a colostomy bag but I suggest that you ask your surgeon about this and his/her reply may/may not influence your decision about surgery.

Finally, I am able to share my surgical experience with you as a further "plank" in making your decision.  I shared this with a patient called "renae241" on the other (community) part of the gastro forums.  Here is how to find it:-

- in the search box at the top right hand corner type in renae241
- then click on the colectomy (second posting down from the top I think) link
- you should find a posting from renae241 dated 20 May to which I have posted a reply

----------

I hope that this helps - do please come back with any further questions - I'll watch this posting for a week or two.

Good luck
Morecambe
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433485_tn?1321816990
Hi.  I had a colon resection ( 7 inches of large sigmoid intestine ) done over 4 months ago.  The reason for mine was 6 episodes of diverticulitis within a 5 month period, as well as the fact that the antibiotics were not controlling it:  it kept coming back.  After about the 3rd episode, the doc started recommending "other options" ( read- surgery).  I did not want to have it but after ending up in the hospital, over the holidays for 5 days, they convinced me that not having the surgery could be "catastrophic" if the colon were to rupture.  Well, my surgery was hand assisted lapro, meaning that it was laproscopic but the surgeon had his hand in my abdomen, as well.  Recovery has not been fun but it was discovered that my colon was starting to stricture ( close up) due to all of the scar tissue from the attacks so I think it was a good idea to have it done.  I would definately recommend another opinion.  Did they do any CT scans on you?  That is how they were able to see some of the scar tissue as well as manipulation of my abdomen.  From what the surgeon said, he "had to do a lot of work in there" with the stricture.
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538870_tn?1213939006
I had cervical neck surgery 3 months ago. After surgery, there was no desire or feeling to poop. The MRI at fist showed full colon and intestines, then after about 30 days, nothing was still working and then we went to the hydrocolonics clinic and had everything cleaned out. Since then, nothing has happened, 100 days with no BM. I have to go to the Hydrocolonics clinic every 3 days now to get cleaned.  They tried everything form Reglan to you name it. THe doc who did the surgery will not talk or answer any questions, we found out that I had stopped breathing several times after the ventilator was removed in the OR. Then when I was finally breathing again after the crash cart came in 3 times, the doc ordered the recovery room anesthesiologist to give me 10 mg of Valium and 160 mg of Oxycontin.  No one knows what's wrong and I have been passed to 7 doctors now. All everyone seems to care about if I am suing the doctor who did the surgery.  Is there anyone who knows what this is??? I was 100% fine prior to surgery.

I was also given Reglan during surgery, and I had no problem for that medication.  
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Avatar_f_tn
Well,

Had the fun test colonscopy-everything ok except for a small pocket of infection in the lower colon. The colon has a small fold in it and there is some infection remaining. Have just finished the lastest round of antibotics and some pain remains. Now the dr is taking a wait and see apporach to see if the infection clears by itself. Will provide update in a week.

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