Diverticulitis attack or flare-up is caused by the massive infection or inflammation of food trapped in pouches that are formed in the intestines. Pouches are called diverticula. Diverticula formed in the intestines are called diverticulosis. Once it gets inflamed or infected, this is called Diverticulitis.
A patient with Diverticulitis will experience the various symptoms of diverticulitis flare-up include:
- Sharp, cramping pain over the lower abdomen, usually on the left side
- Constipation or diarrhea
- Tenderness over the abdomen’s affected area
Some of the symptoms may lead to a severe level that why the patient should seek immediate medical attention. Possibly, the patient will rush to the emergency room.
Diverticulitis treatment in the hospital
In the emergency room, the patient will be required to get blood tests for checking if there is an infection in his/her body. The patient will undergo a physical inspection to sense its tummy hardness and hear his/her scream under pain of pressure.
Other tests may include ultrasounds of the abdomen, CT scans, and x-rays of the stomach. These tests might show pouches in the intestines and inflamed areas.
The patient will be admitted to the hospital and will be treated with antibiotics infusions into his/her bloodstream.
In most common cases, oral antibiotics are given to those with uncomplicated diverticulitis. Antibiotics can lessen the symptoms of diverticulitis attack for a short-termed. If a patient is treated using antibiotics, he or she must be fully taken the antibiotics as directed by the doctor. Taking his/her antibiotics will last up to two weeks. The patient will begin to feel better within 24 hours.
According to Medscape, there are certain oral antibiotics combinations for uncomplicated acute diverticulitis. It is a combination of ciprofloxacin (or trimethoprim-sulfamethoxazole) and metronidazole. The appropriate oral antibiotic for outpatient treatment of uncomplicated diverticulitis is Amoxicillin/Clavulanic acid.
How long can a bout of diverticulitis flare last
The patient’s diverticulitis attack may last up to 2-3 days. It depends on the medical treatments and antibiotics he or she will get. After the emergency is over, the patient may take several weeks to recover. The patient will be released from the hospital with some antibiotics prescriptions and diet recommendations.
Recovery from Diverticulitis
The patient will instruct to drink plenty of fluids while in recovery. It will help the patient to rest his/her intestine from stress. If a patient has another disease that needs limits from fluids, consult his/her doctor first before increasing the number of fluids that need to take.
The patient should have a bland diet, eating food like plain rice, bananas, crackers, applesauce until the recovery time. The patient’s intake of regular foods can gradually return little by little. Increasing his/her source of fiber in a diet is highly recommended.
If the patient experiences sudden mild cramps and pain, he or she can use a heating pad set on the lower part of the belly to ease the tension. The patient should get extra rest until the condition improves.
Read and follow all the instructions on the label. The patient needed to take the pain medicine prescription as prescribed. The patient must not stop taking it just because the feeling gets better, it is still needed to take its full course of antibiotics. If any pain medicine prescription is not given, ask the doctor first what is appropriate, over-the-counter medicine should be taken.
Repeating episodes of Diverticulitis
About 20%-35% of patients will have recurrent episodes of diverticulitis. Each episode brings them closer to resection surgery.
Surgery may recommend if the patient has these several signs or symptoms:
- Multiple frequent episodes of diverticulitis result from uncontrolled medications and sudden lifestyle changes
- The intense pain of the abdomen for several days
- Diarrhea, Constipation, or Vomiting for several days
- Bleeding from your rectum
- Blockage in colon
Different surgeries can perform, on a person diagnosed with repeated episodes of diverticulitis flare-up. These are:
- Bowel resection with Primary Anastomosis
- Hartmann’s Surgery
- Elective Sigmoidectomy
- Bowel resection with colostomy
Bowel resection with Primary Anastomosis
The primary anastomosis utilizes when there is a blockage in the intestines. These an obstruction that needs immediate attention. Not being able to pass out the stool, having belly cramps, and vomiting are the symptoms of obstruction.
In anastomosis surgery, a damaged part of the intestine cut-out, both ends of the intestine connect with sutures or pins. The most primary anastomosis was done using laparoscopic surgery, preventing large incisions of the patient.
To perform a bowel resection with primary anastomosis, the surgeon will cut three to five small openings in the abdomen to view the intestines. Next, the surgeon will insert a laparoscope and other surgical tools through the cuts. The abdominal area is filled with gas to disperse the different organs. Surgeons will look at the organs to locate the damaged parts. Will find the affected part of the intestines, cut it from the rest of the intestines, and take it out. Sew the two remaining ends of your intestines back together. Sew up the surgical incisions and clean the areas around them.
Hartmann’s surgery is removing the diseased portion of the colon and cleaning out the infected intestines in the abdominal cavity. It is a resection of the rectosigmoid colon with the closure of the rectal stump and end colostomy. In the rectal stump, the bowel cut-out. One end is brought up onto the surface of the abdomen as a colostomy.
The infection of the colon is unsafe for the two ends to be reconnected immediately during the surgery. That is why the other end is sewn or stapled to be closed.
It may be reattached again after a few weeks of recovery of the colon. And the bowel can return to its normal function. In the meantime, the stool will leave the body through the stoma. The stoma is an opening that connects to the surface of the abdomen. It is collected by an odor-proof container called a colostomy bag, that is attached to the opening skin outside of the abdomen.
This surgery uses general anesthesia. There are two types of techniques Hartmann’s Surgery uses. An open technique which opens the belly wide open and laparoscopy.
Elective Sigmoidectomy / Sigmoid Resection
The sigmoid colon is in the section of the large intestine that comes before the rectum. In these parts, most pouches occur because this section experiences most pressure on the wall of the intestines from emptying the bowel.
It is done when the affected part of the colon is the sigmoid colon. The damaged parts will be removed along with a small area of the rectum to cut off pouches that can trap food, and help prevent further recurrence of diverticulitis attack. Patients recommend undergoing these surgeries after they have had two or three episodes of diverticulitis flare-ups.
The doctor will conduct some tests before proceeding to these surgeries. General anesthesia will inject to put the patient in a sleep-like state. In this surgery, two techniques are used; which are open surgery and laparoscopic surgery. In open surgery, to identify the damaged section of the sigmoid colon, an incision will be made along the patient’s abdomen to provide access for the surgeon to observe the colon. While in laparoscopic surgery, a small camera is inserted in one of the ports (incisions that are made in the abdomen), by the surgeon to go directly to the colon to see the damaged part. Damaged pieces of the sigmoid colon are pulled using surgical instruments inserted into the port. It will operate externally before reinserting. In this surgery, it is possible to reconnect the healthy end of the bowel to still normally function. Also, there are situations that doctors will need to form a stoma. When the bowel needs time to heal before it attaches, or too much bowel has to remove. It could lead to a permanent or temporary state.
Bowel resection with Colostomy
The colostomy is one of the most common types of surgery for diverticulitis, denominator of the first three surgeries that explained above. The surgeon will cut the colon to remove the damaged pocket or pouches. It may reattach the healthy end of the colon through the open port part of the outside skin of the abdomen called “stoma”.
The colostomy may be created by a surgeon when the colon needs time to recover for a few weeks. An odor-proof container called a “colostomy bag” will be attached to the stoma and provide an alternative channel to allow stool to exit through the stomach. The colostomy bag must be emptied manually.
Performing the colostomy in parts of the colon will depend on why you need it. It will be made in the three parts of the colon:
- This is performed on the right side of the abdomen. It will only leave a short part of the colon active. This is used when there is a blockage or severe disease and prevents a colostomy from going through the colon.
- This is performed on the lower left side of the abdomen.
- This is performed in the middle section of the abdomen. Stool leaves the colon through the stoma before reaching the colon. This is used when there is a blockage, inflammatory bowel disease, and cancer. There are two openings for the stoma; one is for the feces, and the other is for the mucus that is produced by the resting colon.
According to United European Gastroenterol J, there were 982 deaths following 134,428 surgical operations for diverticulitis. This is a 0.7% mortality rate in these types of surgery.
It also stated that up to 22% who already undergo surgical treatment, still have the possibility of having a repeated episode of diverticulitis.
Diverticulitis is a hard emergency situation that is life threatening. It most often requires to be treated in a hospital. It can lead to resection surgery that will impair the ability of the body to digest food.
This is another example that being “moderately” healthy is far better than the best medical treatment you can get.
Diverticular disease prevention and treatment
What Is Anastomosis?
What to know about diverticulitis surgery
Sigmoidectomy surgery for inflammatory bowel disease (IBD)
Surgery for Diverticular Disease
Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006
Diverticular disease and diverticulitis: Surgery for diverticulitis and diverticular disease
Diverticulitis in the Urgent Care Settings
When to Go to the ER for Diverticulitis
Could the Pain in Your Abdomen Be Caused by Diverticulitis?
Diverticulitis Treatment & Management