Diverticulitis

Treatment

Treatment of diverticulitis depends on the severity of symptoms and how many acute episodes the patient has experienced. If symptoms are mild, a liquid or low-fiber diet and antibiotics may be recommended. Those at risk of complications, or who experience recurrent attacks of diverticulitis, may require surgery to remove the diseased portion of the colon.

The patient's age at the time of the attack may be an important factor in the treatment plan. Physicians at Mayo Clinic typically recommend that patients younger than 50 receive more aggressive treatment than patients older than 50. Studies have shown that younger patients may be at a higher risk for recurrent attacks and complications such as a perforated or abscessed colon.

Self-Care

If diverticulitis is treatable at home, patients should expect to remain quiet for a few days. Antibiotics will be prescribed to help kill the bacteria causing the infection. Patients will also temporarily need to avoid all whole grains, fruits and vegetables, so the colon can rest and heal. Once symptoms improve (often in 2 to 4 days) patients can gradually start increasing the amount of high-fiber foods in their diet.

Hospitalization

About half of those who have diverticulitis require hospitalization and many need intravenous antibiotics. People may need to be hospitalized for vomiting, a fever above 100 degrees Fahrenheit, a high white blood cell count, or high risk of a bowel obstruction, peritonitis or other complications.

Surgery

Two procedures are used at Mayo to treat serious cases of diverticulitis. They are performed by surgeons who have completed training in both general surgery and colon and rectal surgery.

Primary Bowel Resection (also called Sigmoid Resection or Segmental Resection)

In this procedure the surgeon removes the diseased part of the intestine and then reconnects the healthy segments of the colon (called anastomosis). This allows the patient to have normal bowel movements. Depending upon the patient's condition, laparoscopic methods may be used in place of traditional surgery. Laparoscopic procedures usually require smaller incisions and enable a faster recovery for the patient.

Bowel Resection with Colostomy

Surgeons use the bowel resection with colostomy procedure (also called Hartmann's procedure) when the colon becomes so inflamed that it is not safe to rejoin the colon and rectum. Surgeons only perform this procedure when the patient experiences a life-threatening infection. The colostomy is usually temporary until the infection and inflammation clear.

To create a colostomy, the surgeon makes an opening in the abdominal wall. The colon is then brought out through the opening, and waste passes through the opening into a bag. A colostomy may be temporary or permanent. Once the inflammation has healed, perhaps several months later, the surgeon may be able to perform a second operation to reconnect the colon and rectum.