Diverticulitis after sigmoid resection

[User713]

36 year old male.  In 2003, diagnosed with 3 cases of diverticulitis.  All  incidents were treated with Cipro/Flagyl by my PCP. Advised after the 3rd incident to get sigmoid colon resection performed, due to age and frequency of diverticulitis. After surgery and modifying my diet to increase my fiber intake, I had not had any problems with diverticulitis up until this past week.  1 week ago started feeling discomfort on left side, higher than prev. bouts. I travelled from NY to FL, the day after I arrived in FL, went to the ER, they performed a CT as well as Xrays and concluded there was diverticulitis in the descending colon, along with a 1mm micro perforation, and that they had seen free air movement.  I was admitted to the hospital on Tuesday and started on Flagyl 500mg/Levofloxacin 500mg by IV.  Another CT was performed 2 days later and reported no change. Was discharged  from the hospital and given Rx for Flagyl 500mg 3x a day as well as Avelox 400mg 1x a day, and instructed to F.U. with my drs in NY.Even though this bout of diverticulitis is clearing on the antibiotics, I think recurrence will be likely, much as it did prior to surgery.  What surgical options am I looking at at this point?  If the diverticulitis clears and I can receive elective surgery, what is likely to be removed?  Can another resection be performed, or are they likely to remove my whole colon?  Will I likely need a colostomy bag for a period of time?

[Forum-M.D.-]

There is always the chance of recurrence.  The antibiotic choice and course is appropriate.  

However, if it recurs, it should be approached similarly to the initial course of diverticulitis - namely, the consideration of surgery if there are repeat episodes.  

I cannot comment on the extent surgery without evaluating you or your medical chart.  Discussion of these options should be done with your personal physician or surgeon.  

Followup with your personal physician is essential.

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

Kevin, M.D.
kevinmd_

[Morecambe]

Maybe it will be informative and helpful to you if I share my own experiences following a total colectomy about three years ago.  I'm 61, male, living in the UK.

I was admitted to hospital as an emergency following torrential diverticular bleeding.  After many tests including an endoscopy and a colonoscopy, it was decided that I should undergo a total colectomy (or sometimes called an ileorectal anastomosis).

The operation took about four hours.  Thereafter pain was well controlled via an epidural/spine drip.  I was encouraged to get out of bed the following day.  Normally the time spent in hospital is about 7 days but I was kept in hospital for 12 days because I developed an "ileus".  This occurs when the remaining intestines are "slow to re-start" and nutrition must be continued intravenously rather than by mouth.  Eventually the ileus disappeared and I returned home on day 12.  I was lucky and did not require a colostomy bag - I was told that this is necessary in only ~2% of cases.  However, it may be worth asking your surgeon if your previous surgery might have disturbed the "geometry" of your remaining intestines such that a colostomy bag is more probable...

This procedure is a big operation and you will feel a bit "beaten up" for ~2 weeks.  The wound will heal well but will still feel delicate and you must not drive a car for ~6 weeks.  Thereafter you will recover slowly and feel normal in ~3 months.  I was able to eat normally but, at first, experienced very loose motions about 8-10 times per day.  Over a few months this reduced to 4-6 times per day with "muddy/sludgy" consistency.  I don't find this more than a minor inconvenience.  It is a good idea to include plenty of fibre (organic bran is especially beneficial) in your diet.

After a visit to the toilet, I suggest gently washing your anus with soapy toilet paper to prevent soreness which might occur after multiple visits to the toilet during the day.   If you are away from home, travelling with a pack of baby wipes is useful to achieve the same effect.

Apart from the above (i.e. more frequent bowel motions), my life is back to normal.

You may want to show this narrative to your surgeon and verify that his viewpoints are more or less parallel with my own experience.
I hope that all goes well for you.  Good luck    

Good luck!!