Diverticular disease, Diverticulitis

Diverticula are protuberances of the intestinal wall that occur most frequently in the lowest section of the large intestine, the sigma, in the area of ​​the so-called high pressure zone. There it concerns so-called pseudodiverticula. So not all wall layers turn out, but only the mucous membrane pushes through gaps in the intestinal muscles, where the blood vessels for the mucous membrane break through the muscles and leave a weak point. The wall is therefore very thin. If such diverticula occur frequently, this is called diverticulosis.

Diverticular disease is a disease of the western world and is associated with a diet rich in carbohydrates and low in fiber.

Stool accumulation in the diverticula causes inflammation of the diverticulum (diverticulitis) itself and the surrounding area (peridiverticulitis). Whether and when diverticulitis will develop from diverticulosis cannot, of course, be predicted, however, statistically speaking, the probability of inflammation is higher in patients with massive diverticular disease than in patients with only one diverticulum. While diverticulosis is usually associated with constipation, abdominal pain, bloating, and flatulence, diverticulitis and its complications can be potentially life-threatening for the patient. The inflammation of the diverticula can lead to abscess formation or to penetration or penetration into other organs, the abdominal wall or into the abdominal cavity. Diverticulitis can also heal with scarring without complications and cause constrictions in this area of ​​the intestine, which in turn favor the occurrence of paradoxical diarrhea as a sign of a severe or relevant constriction in the intestine or even an intestinal obstruction.

The diagnosis is carried out using computed tomography (with a contrast agent inlet). In the case of unclear constrictions, a colonoscopy should not be carried out in the inflammation, but after it has healed.

The uncomplicated diverticulosis can be managed well with a fiber-rich diet and sufficient fluid intake and therefore rarely requires further therapy. In mild diverticulitis, therapy is conservative with antibiotics, anticonvulsant medication, food abstinence and sufficient fluids. The indication for surgery is only made if conservative therapy fails, if the course is repeated or complicated, or if the patient is very young. The absolute indication is given in the case of a breakthrough into another organ or in the case of a covered perforation and acute with emergency surgery in the event of a free breakthrough into the abdominal cavity with the threat of peritonitis. In this case it is a serious situation and the death rate is still high at up to 24%. If the operation is planned, the bowel resection is usually performed minimally invasively, laparoscopically. In this case, the piece of intestine carrying the diverticulum is removed and then the feeding and the discharging leg are reconnected. A temporary exit is only necessary in the rarest of cases, but it is much more common in emergency operations. In order to achieve the lowest possible complication rate, the operation should be performed in an inflammation-free interval if possible.

The operation is mostly very well tolerated. Preparation is similar to that for a colonoscopy. The microbiome (the sum of the bacteria in the body, but mostly the intestine is meant), & nbsp; especially the biodiversity, plays an essential role for the overall process, wound healing and the healing of the intestinal union (anastomosis). For this reason, drugs are used to optimize the microbiome and eliminate "bad" germs before an operation. The operation is about 95% minimally invasive (keyhole technique) with hardly visible scars in the so-called fast track or optimal track concept with the most modern devices (3D and 4k optics) using the latest technology. This means that pain is practically non-existent, early mobilization and rapid nutrition are guaranteed, and the hospital stay is very short. There are no negative short-term or long-term consequences after the operation. You can then lead a completely normal life again and have no restrictions from the operation. 3 months after the operation, the intestinal union (= anastomosis) is checked endoscopically. Further endoscopies are recommended in accordance with international recommendations or depending on your personal risk profile.