Complicated Diverticulitis Treatment | Pristyn Care

Risk Factors

Risk factors for complicated diverticulitis:

• Immunocompromised state (steroids, diabetes, renal failure)
• Age over 65 with sigmoid diverticulosis
• Obesity increasing intra-abdominal pressure
• NSAID use impairing mucosal healing
• Low-fibre diet contributing to diverticulosis
• Prior episodes of acute diverticulitis

Who Is at Risk

Elderly patients over 65 with known sigmoid diverticulosis, immunocompromised individuals, those on NSAIDs or steroids, and patients with two or more prior episodes of acute diverticulitis are at highest risk for complicated disease.

Diagnosis

Diagnostic evaluation includes:

• CT abdomen-pelvis with contrast (gold standard for staging and complication assessment)
• Blood tests: CRP, WBC, blood cultures in septic patients
• Cystoscopy or CT cystogram for suspected colovesical fistula
• Colonoscopy after resolution (6-8 weeks) to exclude malignancy
• MRI pelvis for fistula mapping in elective cases

Treatment: Laparoscopic Sigmoid Colectomy

Pristyn Care performs elective laparoscopic sigmoid colectomy with primary anastomosis for recurrent and complicated diverticulitis. Emergency cases receive Hartmann’s procedure, with reversal offered at 3-6 months if fit.

Sigmoid Colectomy Procedure

Procedure involves:

• Pre-operative bowel preparation and stoma siting (if stoma planned)
• Laparoscopic approach with 4-5 ports
• Medial-to-lateral mobilisation of the sigmoid mesentery
• High ligation of the inferior mesenteric artery and vein
• Specimen extraction through Pfannenstiel or extended port incision
• Stapled colorectal anastomosis with defunctioning loop ileostomy if needed
• Hartmann’s procedure (end colostomy + rectal stump) in emergency/contaminated cases

After the Surgery

Post-operative care includes:

• ERAS protocol: early diet, mobilisation, and multimodal analgesia
• Stoma care training if colostomy or ileostomy formed
• Colonoscopy at 6 weeks post-recovery to exclude malignancy
• High-fibre diet and adequate fluid intake long-term
• Planning of stoma reversal (Hartmann’s reversal) at 3-6 months
• Surgeon and colorectal nurse specialist follow-up

Possible Complications of Diverticulitis Surgery

Potential complications include:

• Anastomotic leak (3-7% in elective, higher in emergency)
• Pelvic abscess and wound infection
• Ureteric injury during sigmoid mobilisation
• Prolonged ileus
• Stoma complications (prolapse, retraction, hernia)
• Recurrent diverticulitis in residual colon