Surgery for recurrent divericulitis?

[tabrc]

I've had 2 hospitalizations for acute diverticulitis and 1 outpatient acute episode in the past 3 months.  My doctors are divided on which approach to use to prevent recurrence.  My surgeon wants to remove  the four inches of my sigmoid colon that are attached to my bladder wall and keep getting infected  causing bladder pain during acute infections, but my gastroenterologist thinks that it is not necessary.   According to the results of my colonoscopy, I have diverticulosis throughout my colon.   If the four inches that keep getting infected are removed, then what is the likelihood that another section with diverticulosis will not become infected?  On the other hand, if I don't have surgery how can I stop the increasingly worse infections.  My diet is high fiber except for 3 weeks after any acute episode.  I am doing my part with diet.  Is surgery the best option?  What about prophylactic antibiotics?  
Would the antibiotic approach  lead to antibiotic resistence or allergy?

[Kevin Pho, MD]

Surgeon has kindly answered your question below and I agree with his assessment.  

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.

Thanks,
Kevin, M.D.

[surgeon]

long-term antibiotics as preventative therapy is not generally recommended. When to intervene, and after how many attacks, is not carved in stone; it depends on severity, at to some degree on how the xrays look, as well as general medical condition. What you describe sounds like there's the potential for developing (or already having) a fistula (connection) between your colon and bladder, which can become a bigger problem. Two hospitalizations certainly puts you in  a category where surgery is to be considered. Most attacks of diverticulitis occur in the sigmoid colon. Many people have diverticula throughout the colon; but if they are concentrated in the sigmoid, then the chance of recurrance is low. Prevention consists mainly of high fiber diet. The old idea of avoiding seeds, etc, has been pretty much disproven. If you've had the attacks despite high fiber and while not being constipated, then there's not much reason to believe you won't have more. No surgery is risk-free; but it's much better to have colon surgery electively than during an emergency due to perforation, etc. If you have a competant experienced surgeon, the chance of problems in recovering from the surgery is very low; and the loss of the sigmoid colon should have no adverse effect on how your bowels or digestion work.

[kevinmd]

Hello - I will be on vacation until August 9th. I look forward to answering your question when I return.

Thanks,
Kevin, M.D.