What is a colonic diverticulum? What is diverticulitis? What is sigmoiditis?
Colonic diverticula are common in the colon (or large intestine). A diverticulum is an outgrowth.
Diverticulitis is the inflammation and infection of a diverticulum (which can cause fever and/or abdominal pain) while diverticulosis corresponds to the presence of several diverticula (which is not or a problem) of variable localization. Diverticula are usually located on the sigmoid colon.
The diverticula can bleed, become clogged and become infected (diverticulitis), perforate and be the cause of more or less serious complications (peritonitis, sigmoido-vesical fistula or communication between the colon and the bladder via a diverticulum; or stenosis causing an occlusion). Under these conditions, your surgeon may need to treat you with fasting, pain medication, antibiotics, sometimes hospitalize you to monitor you or operate on you urgently. It is in particular to avoid having to carry out a surgery with serious consequences for you (by laparotomy or a large scar and with the creation of an artificial anus) that your surgeon can, depending on your history, offer you an intervention in order to avoid that these episodes of diverticular infection do not recur and are potentially more serious and more complicated to manage.
Role of surgery (colectomy or sigmoidectomy) in colon diverticulitis
Resection of a colonic segment is a colectomy. The resection of the sigmoid (which is the colonic segment most frequently affected by diverticula) is called a sigmoidectomy.
In times of crisis (diverticulitis), depending on your symptoms (pain, fever), the results of your blood tests and imaging exams, your surgeon can offer you several treatments that can sometimes be performed at home and sometimes require medical attention. hospitalization
- Fasting and pain medication.
- Fasting, antibiotics and pain medication.
- Fasting, antibiotics, pain medication, and x-ray drainage of an abscess.
- Fasting, antibiotics, pain medication and exploratory laparoscopy (washing of the peritoneal cavity).
- Fasting, antibiotics, pain medication, exploratory laparoscopy (washing of the peritoneal cavity) and resection of the intestinal segment removing the diverticula causing the symptoms and creation of an artificial anus (or stoma).
It is to avoid carrying out a heavy surgical procedure (making an artificial anus or stoma) that your referring doctor and your surgeon may suggest the removal of the colon segment carrying the diverticula (especially if they have been the cause of infectious outbreaks)
For this we have 2 techniques:
- Either by a classic and old technique by an incision under the navel creating a scar of approximately 10 to 15 cm.
- Either a more recent and more modern technique by laparoscopy (5 incisions of one centimeter each) which has the advantage of being very non-aggressive, it reduces post-operative pain and allows a rapid resumption of daily activities.
Given these elements, we most often carry out the surgical treatment of colon diverticula by laparoscopy during a hospital stay of 5 to 10 days.
What is your journey during a sigmoidectomy for colonic diverticulitis?
After having met your surgeon, who has confirmed that it was necessary to remove this segment of colon carrying diverticula which have been or are the cause of pain, fever, abscess or peritonitis, you will meet your anesthetist who will ensure that general anesthesia is possible.
You must remain on an empty stomach for a few hours before the procedure and you will be advised to eat a diet without fiber (vegetables and fruits). If you take medication on a daily basis, you should discuss this with your surgeon and your anesthetist, who may want you to take some of your medication on the morning of the procedure with a background of water. If you take aspirin or medication to thin your blood, tell your surgeon and your anesthesiologist.
The Charcot clinic team (Lyon) welcomes you during admission the day before the intervention when it is scheduled or urgently if your condition justifies it, it checks the administrative formalities, ensures that there is no new information and that the instructions given before the intervention (shower, fasting, etc.) have been followed.
Then you are taken to the operating room in the operating room, your surgeon, your anesthetist surrounded by their team welcome you and carry out the usual checks (identity, compliance with instructions, etc.).
Once asleep, your surgeon, aided by a camera and instruments passing through trocars, will check the artery supplying the colon segment and remove it. Like a pipe of which a piece is cut in the middle to remove it and for which a weld is made which allows the pipe to be reused, your surgeon, after having removed the segment of the diseased colon, will make a seam in order to restore continuity to your intestine.
The duration of the intervention varies from 2 to 3 hours and depends on the difficulty that your surgeon may encounter depending on the state of your colon and the inflammation of the abdominal cavity. A blade can sometimes be put in place, it will be gradually withdrawn like the urinary catheter.
Once awake, after a few hours in the recovery room, you return to your room. A nurse on the ward makes sure that you are not in too much pain, that you are not nauseous or vomiting, that you gradually come to your senses. A snack is served. Your surgeon comes by at the end of the day to make sure that you are well, authorize the gradual resumption of food (first a few drinks then solid food) and give you post-operative instructions. A hospital stay of 5 to 10 days is necessary.
How are the days after a sigmoidectomy?
Usually, this intervention is not very painful and the pain responds well to simple analgesics (paracetamol) which will also be prescribed to you when you leave the hospital. You can get up the evening of the operation or the next day at the latest. You can drink from the evening of the operation and gradually resume a normal diet.
Recovery may sometimes be necessary.
Once at home, you can gradually resume your daily activities and light activity.
A work stoppage of 2 to 4 weeks will be prescribed for you (taking into account the particularities of your work)
Pain under the ribs or towards the shoulders may appear the day after the operation. They are due to laparoscopic gases. These pains always disappear in 24-48 hours.
One month after the operation, you go to your post-operative consultation. Your surgeon then authorizes you to resume your physical and sporting activities.
What complications can arise after a sigmoidectomy?
The removal of a segment of the colon is a frequent operation, the technique of which is precise, but as with any operation, certain complications may arise: a reaction to anesthesia, bleeding, a wound in an abdominal organ, especially when the surgical dissection is difficult.
Local changes discovered during the operation or the appearance of an unexpected complication may lead your surgeon to modify the operation initially planned in order to do everything possible to remedy the difficulties encountered. The laparoscopic approach can also be converted into a laparotomy (conventional surgery via a scar under the umbilicus). Sometimes the state of your intestine can make it dangerous for you to make a seam (or suture) which would allow the restoration of digestive continuity. Then, a temporary artificial anus (or stoma) can be made to allow you a speedy recovery.
The intestine is “inhabited” by millions of bacteria allowing digestion, it remains a fragile organ. In the days following the intervention, the quality of the healing of the anastomosis (or suture allowing the restoration of digestive continuity) will be monitored. A fistula (rupture of the anastomosis) can occur in 5% to 10% of cases, according to the scientific literature. This rupture of the anastomosis can occur in the days following the intervention and require a new operation with the making of a temporary artificial anus. The ureter which conducts urine from the kidney to the bladder is very close to the sigmoid colon and can sometimes be damaged, requiring specific treatment.
A wall abscess may occur and require nursing care. The list of complications described is not exhaustive, but it is important to understand that one of the objectives of the pre-operative consultation is to allow your surgeon to balance the risks that you would take by not being operated on with the risks inherent in an intervention. If an indication for surgery has been retained, unlike cosmetic surgery, it is because there would be a greater risk of not carrying out the intervention (peritonitis). If in doubt on your part, do not hesitate to ask your surgeon for clarification. The complications described may make you anxious, but they remain exceptional thanks to a precise technique.
Post-operative advice after a sigmoidectomy
Resume very light activity, walking is allowed, avoid driving for 5 days. It is normal for the surgical area to be painful at first and will remain sensitive for some time. This should not prevent you from moving, walking and carrying out the acts of daily life.
During your recovery:
- It is advisable to take showers (the bath is to be avoided for a month).
- Do not carry heavy loads (for at least one month).
- on prescription from your anesthesiologist: wearing compression stockings (for the entire duration of the anticoagulant treatment).
- In case of laparotomy: an abdominal belt (until the next consultation) will be prescribed for you and must be worn until the next consultation.
- In case of exposure to the sun, provide protection against UV (total sunscreen cream) the best solution is to wear clean clothing to cover the scar.
- Avoid practicing sport until the next consultation.
- You have to leave the scars exposed. There is no need to bring in a nurse.
- The threads on your scar are absorbable, they can get wet and will disappear on their own. After your shower, pat the scars dry with a clean towel.
Food can be resumed without restriction, but in moderation.