What is Diverticulitis?

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Center for Colorectal and Pelvic Floor Disorders (COPE)
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Creve Coeur, MO 63141

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Progress West Healthcare Center
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O'Fallon, MO 63368
Phone: 314-454-7177     Fax: 314-454-5249
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Question: I have just been discharged from the hospital after a bout of diverticulitis. Do I need to have surgery or can I just change my diet?

Answer: Diverticulitis is an infection which arises from a perforation of a small diverticula (colonic outpouchings). Symptoms range from mild pain in the left-lower abdomen and low-grade fevers to more severe, generalized peritonitis – resulting in the possible need for emergency surgery.

Patients with lower abdominal pain, fevers and an elevated white blood cell count can be initially treated with antibiotics. CT scans stratify patients according to the severity of their disease and if an abscess is found, can be used to guide drainage. Per-cutaneous (through the skin) drainage converts an urgent surgery to an elective operation. Colonoscopy and contrast enemas are not done during an attack.

Mild diverticulitis is treated with oral antibiotics. Individuals with higher fevers and severe pain are treated in the hospital with intravenous antibiotics. Approximately 10-to-20 percent of patients can be expected to have a recurrence of diverticulitis. The more complicated the attack, the higher the risk of recurrence.

Six-to-eight weeks after the first attack of diverticulitis, patients should undergo full colonic evaluation (colonoscopy or contrast enema) to rule out carcinoma. Patients are started on a low-fiber diet, which is gradually increased to reach a total intake of 20-to-30 grams of fiber per day. There is no data to support avoidance of seeds, nuts or corn in order to prevent attacks of diverticulitis.

Surgery is recommended for patients with complications such as abscesses and fistulae (leakage of bowel into the vagina or bladder). It is recommended that patients with multiple attacks (greater than four) consider surgical resection.

Surgery involves removal of the involved segment of colon. Since most diverticulitis occurs in the sigmoid colon, the most common operation is removal of a portion of the left colon. Colostomies are generally not indicated if the operation can be done electively. A laparoscopic approach is a preferred approach if all of the inflammation has resolved and the surgeon feels it is indicated.

If this is your first attack, surgery would not be recommended. You should start a high-fiber diet after the pain resolves. In addition, make sure that your entire colon is evaluated. If you have subsequent attacks, discuss your surgical options with a surgeon who treats this disease regularly.