What are the indications for colon resection (colectomy) in patients with diverticular disease?

Updated: Apr 05, 2021
  • Author: David E Stein, MD, MHCM; Chief Editor: Vikram Kate, FRCS, MS, MBBS, PhD, FACS, FACG, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS, FFST(Ed)  more...
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Answer

Not all cases of diverticulosis necessitate colon resection. In fact, diverticulosis is usually asymptomatic and is often an incidental finding on screening colonoscopies or diagnostic laparoscopies. However, when diverticulosis is complicated by diverticulitis or if it presents with massive bleeding, a colon resection may be required.

Diverticulosis

Mucosal and submucosal outpouchings in the colon are called diverticula. They are false diverticula and are a phenomenon of a diet low in complex carbohydrates and dietary fiber. By age 70 years, more than 50% of people in the United States have colonic diverticulosis.

In general, the only operative indication for surgery in diverticulosis is for hemorrhage. Diverticulosis may cause a massive lower gastrointestinal (GI) bleed, and if this cannot be controlled with endoscopy or interventional radiology, surgery may be required. If the area of the bleed is localized with angiography, a segmental resection corresponding to the bleeding may be performed. In an unstable patient or one who has been transfused with more than 10 units of blood upon hospital admission or more than 6 units of blood in 24 hours or is hemodynamically unstable, an emergency subtotal colectomy may be required.

Diverticulitis

Diverticulitis is a perforation of a diverticulum. Diverticulosis does not always result in diverticulitis. Furthermore, not all cases of diverticulitis warrant colon resection. Acute uncomplicated diverticulitis can often be treated successfully with bowel rest and antibiotics alone. The decision to undergo surgical intervention is made on a case-by-case basis. [10]

The indication for colon resection is recurrent attacks or complicated diverticulitis, which is characterized by perforation, obstruction, abscess, or fistula. In general, the authors try to convert an emergency procedure into an elective one. In a case of a free perforation with feculent peritonitis, a Hartmann procedure is often performed, which involves resection of the inflamed segment of large bowel followed by an end colostomy and a stapled rectal stump. The colostomy can then be reversed 3-6 months postoperatively.


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