Operation
In 5% of patients with diverticulosis, surgery is necessary due to moderate to massive bleeding. In most cases, however, the sources of bleeding dry up without the need for surgery. In case of uncomplicated diverticulosis, surgery is not justified.
The risks of an operation outweigh the possible risks of a not yet or only slightly symptomatic disease, whose course cannot be predicted. Only if at least two inflammatory attacks of diverticulitis occur, surgical removal of the repeatedly inflamed intestinal area should be considered. This should reduce the probability of complications in the event of a new inflammation.
As a rule, the planned surgery is not performed until the inflammation in the bowel has calmed down. In young and high-risk patients, surgery is often decided earlier, sometimes after the first episode, because the risk of recurrence is higher in these patients. The laparoscopic keyhole technique is usually used during the operation, among other things to ensure faster and less complication-prone wound healing.
For this purpose 4 small incisions are made in the abdominal wall. CO2 gas is pumped into the abdominal cavity to create a better field of vision and work. A small camera and the surgical instruments are then inserted into the abdominal cavity through the small incisions.
The inflamed section of intestine is identified, separated out and the two ends of the intestine are sutured with a suture aid. After the operation, patients usually feel immediate relief of the symptoms. In the first days after the operation, the intestine, especially filled, is still painful. However, these complaints usually subside quickly. Once the surgical wounds have healed, the bowel movement is usually softer than before due to the shortened intestine.Otherwise, nothing changes for the patients.
Complications
In diverticulosis, bleeding occurs in 10-30% of cases, but 80% of the bleeding sites close up on their own. If the diverticula filled with intestinal contents become infected, about 20% of the diverticula carriers develop diverticular disease or acute or chronic diverticulitis. Inflamed diverticula can burst and lead to an infection in the abdominal cavity.
Depending on the size of the defect and the amount of intestinal bacteria entering the abdominal cavity, different clinical pictures can develop. If the tear or intestinal perforation is sealed by other organs, a skin or capsule, it is called a covered perforation. This usually leads to local inflammation with abscess formation (capsule with pus accumulation).
After the abscess has healed, a wound (fistula) may remain between the intestine and surrounding organs such as the bladder or ovary. Intestinal contents can thus reach other organs and cause inflammation in these places. A free perforation (intestinal breakthrough) requires intestinal contents to pass through the hole in the intestinal wall into the abdominal cavity.
This usually leads to severe peritonitis. Sepsis (blood poisoning) with possible fatal consequences are further complications of an intestinal rupture with peritonitis. After each inflammation, scars form in the peritoneal cavity and in the intestine.
These can either constrict the intestine from the outside or reduce the diameter of the intestine from the inside. The passage of stool is thus restricted by the constriction. If the intestine is completely squeezed or constricted, an intestinal obstruction (ileus) occurs, which urgently requires surgery.
