Diverticula are protrusions of the intestinal wall. The S colon, immediately prior to the rectum, is by far the most frequently affected by diverticula. However, in principle they can occur across the entire large and small intestine. In most cases, diverticula do not cause any symptoms and are often discovered coincidentally during a preventive colonoscopy and do not require any treatment. An inflammation of the diverticula is referred to as diverticulitis, which typically causes pain in the left lower abdomen and is usually treated with antibiotics. Only one third of those affected by diverticula develop symptoms in the sense of diverticulitis or, more rarely, bleeding. In the case of typical left-sided lower abdominal pain and elevated infection levels in the blood, a computer tomography is usually performed to confirm the diagnosis and to exclude possible complications (intestinal perforation, abscess, etc.). In the acute stage, treatment is performed with the administration of antibiotics. In particular, in the case of an initial diagnosis, a colonoscopy is urgently recommended after the inflammation has healed, to exclude a tumor.
An antibiotic therapy is also initiated in the case of a complicated diverticulitis with a covered intestinal perforation or abscess formation. In the event of a good response to therapy, removal of the affected bowel section during the inflammation-free interval is discussed, depending on the patient's age and underlying diseases. Immediate surgery is indicated if the complicated diverticulitis fails to heal with conservative therapy or if a free intestinal perforation into the abdominal cavity is already present.
Diverticular surgery can be performed openly by way of an abdominal incision or laparoscopically ("keyhole technique"). This involves removing the diverticulum-affected S-intestine and joining the remaining ends of the intestine with special staplers. In the case of emergency surgery with contamination of the abdominal cavity, an artificial bowel outlet may need to be created, which can be repositioned after complete healing.
After an experienced diverticulitis, the risk of a new inflammatory episode is very high (up to 70 percent). After surgery, the recurrence rate is zero to two percent. Therefore, surgery is clearly recommended for recurrent episodes of diverticulitis or complications that have been experienced.
