BayCare Medical Group Surgeon Gives Insight on Diverticulitis

Dr Brett Armstrong explains the details of diverticulitis and what common symptoms and treatment options are available to patients.

Diverticulitis is one of the more common pathologies we see as General Surgeons. It is estimated that by the age of 40, 40% of Americans will have Diverticulosis, the underlying disease that causes Diverticulitis. This increases by about 10% per decade. Particularly in North Tampa, Diverticulosis is very common. The underlying pathology (Diverticulosis) is a weakening of the colon wall that leads to an outpouching, like a balloon. These outpouchings are prone to inflammation and rupture. This leads to the acute disease known as Diverticulitis. The cause of Diverticulosis is multifactorial. Most Americans tend to have a low-fiber diet. Particularly with recent trends towards high protein diets, diverticulosis has become more common. This, in combination with the anatomic S-shape of the last part of the colon (hence the name “sigmoid”), leads to higher pressures that cause the outpouches. Every so often, and largely for reasons that are not completely understood, one of these diverticuli become inflamed and perforate leading to diverticulitis.

Diverticulitis Symptoms
• Abdominal Pain
• Nausea
• Vomiting
• Fever
• Abdominal Tenderness
• Constipation

Healing and Treatment Options
There is then a spectrum of how severe diverticulitis becomes. For small perforations that spontaneously heal, they can be treated with outpatient antibiotics. For more severe cases, they require inpatient hospitalization, IV antibiotics, bowel rest, and at times additional procedures. The most severe cases of diverticulitis require emergency surgery. Unfortunately, due to the active infection, the only surgery we can offer is to remove the colon and place a temporary colostomy (or “bag”) until the infection resolves. It goes without saying that it is preferable to prevent diverticulitis from progressing to this point.

Diverticulitis is Progressive—How to Manage Symptoms
Once diverticulosis develops, there is no way to reverse the damage. A high fiber diet is encouraged to stop the progression of the disease. It used to be thought that nuts, seeds, popcorn, etc. could prevent attacks, however recent literature suggests this is not necessarily true. Diverticulosis may be diagnosed and monitored with routine colonoscopy.

Surgical Options for Severe Cases
Surgical resection of the affected colon is the only potential cure we can offer. This is typically reserved for patients that have had one or more bouts of complicated diverticulitis. The colon can be removed with a laparoscopic (minimally invasive) surgery with a goal of complete removal of the affected colon and a stapling of the colon together without the need for a colostomy. It’s about two weeks of recovery, and 2-3 days in the hospital. There are of course risks to surgery, and your surgeon will review those with you before proceeding. Surgical resection is not right for everyone, and your surgeon can help you decide if this is the best option for you.

If you have been diagnosed with diverticulitis in the past and would like to discuss your surgical options, your BayCare Medical Group surgery team at St. Joseph’s North is available to meet with you at any time. Please call (813) 264-6490.

Brett A. Armstrong, MD
Dr. Brett Armstrong specializes in general surgery. Dr. Armstrong received his undergraduate degree in biology from Florida State University in Tallahassee, Florida. He then earned his Doctor of Medicine from the Florida State University College of Medicine in Tallahassee. He continued his medical education by completing a general surgery residency at Memorial Health University Medical Center in Savannah, Georgia. Dr. Armstrong’s clinical interests include abdominal hernias and colorectal surgery. He is a member of the American College of Physicians and Florida Medical Association. Dr. Armstrong speaks Spanish.