What is a small bowel diverticulum? What is diverticulitis?
Diverticula are more common in the colon (or large intestine) and rarer in the small intestine (or “small intestine”) but not exceptional. A diverticulum is a growth, a pea-sized protrusion from the wall of the digestive tract.
Diverticulitis is the inflammation and infection of a diverticulum (which can cause fever and/or abdominal pain).
The diverticula can bleed, clog and become infected (abscess, peritonitis), and perforate and be the cause of more or less serious complications. Under these conditions, your surgeon may have to treat you with fasting, with pain medication, antibiotics, sometimes hospitalize you to monitor you or operate on you urgently. It is in particular to avoid having to carry out surgery with serious consequences for you (by laparotomy or large scar and with the creation of an artificial anus) that your surgeon may, depending on your history, offer you an intervention in order to avoid that these episodes of infection of the diverticula do not repeat themselves and are potentially more serious and more complicated to take care of.
Role of surgery for small bowel diverticulitis
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 a 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 segment of intestine carrying the diverticulum causing the symptoms and making of an artificial anus (or stoma).
It is to avoid carrying out a surgical procedure with serious consequences (making an artificial anus or stoma) that your referring doctor and your surgeon may offer you the removal of the segment of small intestine carrying the diverticulum of the small intestine.
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 (3 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 small bowel diverticula by laparoscopy during a hospital stay of 5 to 7 days.
What is your journey through small bowel surgery for diverticulitis?
After having met your surgeon, who confirmed that it was necessary to remove this segment of small intestine bearing this or these diverticula which were or are the cause of pain, fever, abscess or peritonitis, you meet your anesthesiologist who will ensure that anesthesia is possible.
You must fast for a few hours before the operation. If you take medication on a daily basis, you should discuss this with your surgeon and your anesthesiologist, 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 operation when it is scheduled or urgently if your condition justifies it, it checks the administrative formalities, ensures that it is there is no new information and that the instructions given before the intervention (shower, fasting, etc.) have been respected.
Then you are taken to the operating room in the operating room, your surgeon and your anesthetist surrounded by their team welcome you and carry out the usual checks (identity, compliance with instructions, etc.).
When you are asleep, your surgeon, aided by a camera and instruments passing through trocars, will check the artery supplying the segment of intestine affected by the diverticulum(s) and remove this piece of small intestine. 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 diseased small intestine, will make a seam in order to restore continuity to your intestine.
The duration of the procedure varies from 1 to 2 hours and depends on the difficulty that your surgeon may encounter depending on the state of your intestine 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 7 days is necessary.
What are the days after small intestine surgery like?
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, towards the shoulders may appear the day after the operation. They are due to the gas necessary for laparoscopy. These pains always disappear in 24-48 hours.
One month after the operation, you go to your post-operative consultation. Your surgeon will then authorize you to resume your physical and sporting activities.
What complications can arise after small intestine surgery?
The removal of a segment of small intestine is a frequent intervention whose technique is precise, but as with any operation certain complications can occur: a reaction to anesthesia, bleeding, a wound of an abdominal organ, especially when 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 with a scar on either side of the navel). Sometimes the state of your intestine can make it dangerous for you to perform a seam or suture that 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 operation, the quality of the healing of the anastomosis on the small intestine (or suture allowing the restoration of digestive continuity) will be monitored.
A fistula (rupture of the anastomosis) on the small intestine can occur in 5% 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 intestine and can sometimes be injured, 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 preoperative consultation is to allow your surgeon to weigh up the risks that you would take by not having surgery with the risks inherent in an intervention. If an indication for surgery has been retained, unlike cosmetic surgery, it is because there would be more risks in not carrying out this intervention. If in doubt, 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.
What to do in case of problems at home after a resection anastomosis of the small intestine for diverticulitis?
You absolutely must contact your surgeon in case of persistent fever, or abdominal pain that resists the medication prescribed after the operation, persistent nausea or vomiting; persistent cough or difficulty breathing or discharge from an incision.
When you leave, the documents provided by your surgeon and/or the nurses in the service include the telephone number of the surgery secretariat and the telephone number of the general practitioner on duty (7 days a week, 24 hours a day) practicing at the Charcot clinic. (Lyons). He can, if he deems it necessary, hospitalize you. Do not hesitate to contact us.
Post-operative advice after small intestine surgery
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.
- 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 and anticoagulant
- In case of laparotomy: an abdominal belt will be prescribed 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. There is no particular diet to follow.
Smoking increases the risk of surgical complications. Quitting smoking 6-8 weeks before the procedure eliminates this additional risk. If you smoke, talk to your doctor, your surgeon and your anesthetist or call the Tobacco-Info-Service line at 39 89 to help you reduce the risks and put the odds in your favor.