Dear Dr. Roach: I’ve had diverticulitis repeatedly since 2016. It’s been bad enough 10 times (with belly pain and fever) that I was given antibiotics. I’ve had it at least that many more times where I wasn’t as ill (usually just had belly pain), and I didn’t take antibiotics, since it went away on its own. I have not needed to be hospitalized for it. I’ve had three or four CT scans during flare-ups that confirmed diverticulitis.
I’m scheduled to have surgery to remove the part of my colon where I keep getting the infections. During the last attack, the emergency room doctor and my primary care doctor said that I need to get it done. The surgeon said it was up to me, laid out the risk involved and told me that there was about a 98% chance that surgery would cure my diverticulitis.
Would you please discuss diverticulitis and your recommendations in your column (including when you’d recommend surgery, or at least a surgery consultation)?
L.R.
Diverticulitis is an infection in the small outpouches of the colon, called diverticula. Most people with diverticula (“diverticulosis”) never get diverticulitis.
In general, I don’t recommend surgery lightly. No surgery is completely free of risk. Elective colon surgery sometimes unexpectedly requires a colostomy. However, in your case, a careful consideration of surgery is appropriate given your multiple recurrences.
It sounds like you have had “uncomplicated” diverticulitis, since you’ve never required a hospital admission. Although we used to treat uncomplicated diverticulitis with oral antibiotics, they do not seem to have much benefit, so they are usually not given. Complicated diverticulitis, fistula, bowel obstruction, peritonitis and bowel stricture are usually treated in the hospital. One important reason to consider surgery is to prevent a complicated episode of diverticulitis, which can be dangerous — even life-threatening.
People with at least one episode of complicated diverticulitis are usually recommended for surgery, as they are at a high risk for another complicated episode. However, your risk for developing a complicated episode of diverticulitis, having had multiple episodes of uncomplicated diverticulitis, is small — about 3%. In my mind, there is no compelling reason to undergo surgery. However, you are very likely to keep getting recurrences of uncomplicated diverticulitis, so it is a reasonable option.
Your surgeon is right about the likelihood of not having diverticulitis again after surgery, but the exact chance depends on where your diverticula are. Most commonly, they are in the sigmoid colon, which is the part that gets removed. It sounds like the surgeon thinks that you are likely to have a favourable outcome based on your anatomy.
Were you my patient, I would ask you how painful and debilitating your episodes have been. If they are generally not so bad, I am unlikely to recommend surgery. However, if you have had prolonged courses of pain and have been unable to do regular activities, I certainly recommend a surgical consultation.
Finally, just a brief word about nuts and seeds: Many of my patients and readers have been told to avoid these, as they can plug a diverticula and cause diverticulitis.
This seems to be extremely unusual, and most data show that nuts and seeds do not increase the risk of a recurrence of diverticulitis, instead decreasing the risk.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
