Should I have surgery?

[carebear312]

I recently spent 4 days hospitalized because of diverticulitis with a microperforation.  They didn't end up doing the emergency surgery and were able to get my diverticulitis under control with a lot of IV antibiotics.  However, the doctors have recommended that I have the surgery on an elective basis in the next couple of months.  The theory is that I am only 34 years old and have a lot of diverticular disease for my age.  The surgeon is convinced that it is only a matter of time before I will need an emergency surgery.  He said that doing the surgery on an elective basis will prevent the need for a colostomy bag.  I have scheduled a second and third opinion for next week.  Does anyone have any suggestion on the types of questions I should be asking?  Also, are there any alternative treatments?  Any advice would be appreciated!

[CalGal]

If your diverticular problems are extensive and have already perforated at your age, there may not be a lot of a choice that can be made at this point. There are little-to-no alternative treatments at the current time. The only thing that is currently being tried is the use of the anti-inflammatory medications such as those used in the treatment of inflammatory bowel disease. Although how successful that is hasn't really been figured out yet.

You need to ask the doc(s) you're seeing how extensive the inflammation/pockets are and exactly where it is. The whole of the large intestine is 'wired' a bit differently than the small intestine. The small intestine has more vascular input - the large bowel has less. And depending on how that vascular input is placed (each person is a bit different), it may affect how much of the large intestine will have to be removed. So you need to know what they're taking about taking out and how much 'more' will have to accompany it to make sure you're well-vascularized after the surgery.

[carebear312]

They said that the majority of my "tics" are in the sigmoid colon.  As of now, they are planning on removing the sigmoid colon.    

[Morecambe]

Just over five years ago I underwent a total colectomy for torrential diverticular bleeding.  Although this is not exactly the same complaint as yours, there are some similarities.

In response to another Medhelp patient's posting, I described my experience on Medhelp under the following posting:-

http://www.medhelp.org/posts/show/523166

You may like to have a look at this, print it off and show it to your surgeon(s) and ask them whether my observations are typical of what you might expect.  You could also ask whether the surgery can be performed laparoscopically rather than "surgeon's hands inside the abdomen".

If your surgeons confirm that they would expect your experience to more or less follow mine then you will have to decide whether you are prepared to undergo the surgery or whether you prefer to pursue other treatments which may cause risks to endure....

I would suggest asking your surgeons "if I do not undergo surgery is there a risk that further perforations may occur and does this carry the risk of peritonitis - and exactly what are the risks of peritonitis?"

regards
Morecambe

[carebear312]

I think part of the complication is that I have a pretty severe case of IBS in addition to the diverticulitis.  The IBS already makes what I can eat very limited because my GI doctor and I have figured out that the things that impact my IBS negatively the most are high fiber foods.  I have already been on probiotics for over a year and have had more than one episode of IBS where the bad bacteria in my stomach takes over the good bacteria and causes bloating and unbelievable pain.  The GI dr has said that when I have high fiber foods, it causes me to bloat, which creates a "breeding ground" for the bad bacteria.  

I think I was a little leary about this advice and thought to myself - how could fruits and veggies actually be bad for you.  So I tried Nutrisystem for a few weeks and ended up in the emergency room because of the amount of pain and bloating it caused!

[carebear312]

Thank you for the advice.  I will print it and take it with me to the dr.  I am seeing three different GI drs this week and 2 surgeons in total to try to make my decision.  The first surgeon (the one that saw me when I was hospitalized), is convinced that this is going to happen again.  He said it is not a matter of if, but a matter of when.  He said that if I decide not to undergo surgery, he would recommend that I never travel somewhere that does not have excellent health care.  

He also said that he would attempt the surgery laparoscopically if I lose 20 pounds before the surgery.  As I discussed above, my IBS makes it very difficult for me to change my diet in a way that is helpful for weight loss.  However, I am determined to lose the 20 pounds in order to make this surgery (if I decide to do it) easier.  I recently joined Curves - although I am still very exhausted from the diverticulitis outbreak.  I just finished my 10 day round of antibiotics on Sunday.  I have the second surgery opinion on Saturday.