How is colonic diverticulum treated?

The article was professionally consulted by MSc Vu Van Quan - Department of General Surgery & Anesthesia - Vinmec Hai Phong International General Hospital.

Colonic diverticula is a common disease in the elderly, often without symptoms, unless these diverticula become inflamed, also known as diverticulitis.

Diverticulents are small, bulging pouches that can form anywhere in the digestive tract, from the esophagus to the stomach, small intestine, and large intestine. However, they are usually found in the large intestine. Diverticulosis is a fairly common disease, often seen in patients over 40 years of age.
When there is a diverticulum in the digestive system, the condition is called diverticulosis. Patients may never know they exist in the body because they rarely cause any problems, unless the diverticula become inflamed.
Colonic diverticula are pouch-like structures that develop in the wall of the colon, most commonly in the sigmoid and left colon, but can also involve the entire colon. When these diverticula become inflamed, it causes diverticulitis.
Diseases of colonic diverticulum:
Asymptomatic colonic diverticulum: 70% of patients have colonic diverticulum but do not show any symptoms during life. 10-25% of patients with colonic diverticulum will develop diverticulitis, and the remaining 5-10% of patients will have bleeding complications of colonic diverticulum. Colonic Diverticular Bleeding: Colic diverticulum hemorrhage accounts for about 5-10% of patients with colonic diverticulum. Gastrointestinal bleeding accounts for 40% of the causes of lower gastrointestinal bleeding and is considered a major cause of lower gastrointestinal bleeding. Diverticulitis usually occurs in the right colonic diverticulum and in 90% of cases the bleeding will stop spontaneously. Colonic diverticulitis: Colonic diverticulitis includes 2 clinical forms: simple diverticulitis (uncomplicated) and complex diverticulitis (or complicated diverticulitis).

The majority of patients with colonic diverticulum do not present with obvious clinical symptoms. The rest of the common symptoms are abdominal pain, usually in the lower left abdomen, accompanied by a feeling of bloating, bloating, bowel disorders: constipation, loose stools, or bloody stools, sometimes symptoms difficult to distinguish from irritable bowel syndrome.
In case of diverticulitis, in addition to abdominal pain, the patient may vomit, have loose stools, constipation, abdominal distention, fever, even high fever, chills; Diverticulosis can also abscess, leak, even perforate, causing bleeding, abdominal infection is very dangerous.

The cause of colonic diverticulum is still unknown. The most commonly accepted theory regarding diverticular disease is that it is caused by high pressure in the colon. This pressure causes weak areas of the colon wall to bulge and form pouches. A diet low in fiber and high in red meat may also play a role. Currently, the cause of diverticulitis has not been determined.

Colonic diverticulum usually causes no symptoms. It can be diagnosed during screening tests such as endoscopy.
If you are experiencing symptoms of diverticulitis, it is important to see a doctor. Your doctor will ask questions about your history (such as bowel habits, symptoms, diet, and current medications) and perform an examination, which may include a rectal exam. Laboratory tests usually include a blood test (for white blood cells, a sign of infection) and a CT scan. In people with rapid, heavy rectal bleeding, a doctor may perform a procedure called an angiogram to determine the source of the bleeding.

People with diverticulosis who have no symptoms or complications do not need specific treatment, however it is important to eat a diet high in fiber, fruits, and vegetables to prevent the formation of pouches. redundant.
Most cases of diverticulitis can be treated with antibiotics in pill form or intravenously (IV). If inflammation progresses to an abscess, it may need to be drained. Once the patient has recovered, a diverticulectomy can be performed.
Surgery for diverticulosis is indicated in the following situations:
A rupture in the colon causes pus or stool to leak into the abdominal cavity, leading to peritonitis, often requiring emergency surgery. Severe cases do not respond to maximum medical treatment including intravenous antibiotics and hospitalization. Patients with immune system problems (eg, related to organ transplantation or chemotherapy). Colonic fistula Abscess drainage failure. The goal of surgery is to resolve the infection (diverticulectomy, colectomy, abscess drainage, abdominal lavage...), to treat associated complications such as intestinal obstruction, gastrointestinal fistula, and restore drainage. intestinal perforation with the lowest morbidity and mortality.
The trend of the world today is laparoscopic surgery. Laparoscopic surgery also has a role in colonic diverticulitis. The outstanding advantages of laparoscopic surgery compared to open surgery are less pain, reduced rate of wound infection, and faster recovery time. Rates of recurrence, complications, and mortality were the same or lower.

Although it has only been implemented since January 2019, but up to now, the number of successful laparoscopic right colectomy surgery has a rate higher than 95%, the average hospital stay is only about 5 day .
Medical standard equipment is the technical highlight of Vinmec Hai Phong, namely:
Full HD laparoscopic surgery system Karl Storz GmbH Laparoscope Ligasure REFVLF 10GEN Next to Therefore, a well-trained professional team is always the strength of human resources at Vinmec International General Hospital system. Laparoscopic colectomy surgery at Vinmec Hai Phong is performed by Master, Doctor Vu Van Quan - Doctor specializing in examination and treatment of surgical pathologies of the gastrointestinal tract, including colon and other pathologies. of the abdominal peritoneum, the abdominal wall. With his extensive practical experience, the doctor has directly conducted many successful endoscopic gastrointestinal surgery in general and right colonectomy in particular.

Master. Doctor. Vu Van Quan has more than 10 years of experience working in the field of General Gastroenterology, specializing in examining and treating surgical pathologies of the gastrointestinal tract, liver, bile, pancreas and diseases of the abdominal peritoneum and abdominal wall.

Article referenced source: fascrs.org