Perforation from colonic diverticulitis almost always occurs on the left side [3]. Well-contained perforations manifest as small and self-limited; however, non-contained perforations which occur in 1 %–2 % of patients with acute diverticulitis may lead to local abscess and fistula formation [4–6] (Fig. 1).
Of all patients with diverticulosis, 10-25 percent will become symptomatic (acute diverticulitis). When you have acute diverticulitis, a perforated colon is not that unusual because diverticulitis causes tiny tears — perforations — in the colon walls. These tears can grow larger and become problematic.
“Generally speaking, inflammation from diverticulitis can cause scar tissue formation and breakdown of the colon wall, and if the colon wall develops a hole, then an abscess will form,” warns Will Bulsiewicz, MD, a gastroenterologist and gut health expert in Mount Pleasant, South Carolina.
In rare cases, a severe episode of diverticulitis can only be treated with emergency surgery. This is when a hole (perforation) has developed in the bowel. This is uncommon, but causes very severe abdominal pain, which needs an emergency trip to hospital.
If you have a gastrointestinal or bowel perforation, you may experience: Abdominal pain or cramping, which is usually severe. Bloating or a swollen abdomen. Fever or chills.
The type of operative intervention for diverticulitis with perforation depends on the patient's hemodynamic status and the extent of the disease. These can include primary resection and anastomosis, Hartmann's procedure, or damage control surgery (Figure 2).
Dr. Nina Paonessa at Paonessa Colon & Rectal Surgery effectively treats most cases of diverticulitis with medication and dietary changes. But if you want to cure the problem to prevent future attacks, you only have one choice, and that's surgery. Learn about when you may need surgery to eliminate diverticulitis.
After you go home, you may have diarrhea on and off during the first month. It takes about three months for the bowels to learn their “new normal.” You'll need to avoid heavy lifting for six to eight weeks to prevent a hernia.
Can diverticulitis go away on its own? If it's mild and uncomplicated, it can go away on its own. But you should still go to a healthcare provider to have it evaluated. They might need to give you antibiotics for an infection, and some people might need prescription pain medications.
An intestinal perforation is a major life-threatening condition with high morbidity and mortality that requires emergency surgery. Despite improvements in surgical and medical treatments, the overall mortality rate is 30% and the mortality rate of cases that also have diffuse peritonitis is up to 70% [1,2,3,4].
Often, patients will not know they have a perforated bowel until symptoms are sever. Early signs of sepsis are: Body temperature above 101 F (38.3 C) or below 96.8 F (36 C) Chills.
Your NYU Langone gastroenterologist may recommend surgery if symptoms of diverticulitis haven't improved after nonsurgical treatment; if a perforation or fistula, a connection that forms between the intestines and another organ, develops in the colon wall; or if a diverticular pouch ruptures.
In most cases, diverticulitis is not considered to be a life-threatening or life-limiting condition.
If left untreated, diverticulitis may lead to a collection of pus (called an abscess) outside the colon wall or a generalized infection in the lining of the abdominal cavity, a condition referred to as peritonitis.
Diverticulitis Recovery Timeline
Recovering from a flare-up of diverticulitis could take as long as two weeks. 1 The first few days of recovering from uncomplicated diverticulitis at home will include following a liquid diet, resting, and using recommended medications for pain relief.
Home remedies for diverticulitis that may be recommended include following a liquid diet, increasing your intake of fiber and anti-inflammatory foods, avoiding red meat and high-fat foods, cutting back on alcohol, exercising, and trying certain supplements.
Mild cases of diverticulitis are usually treated with antibiotics and a low-fiber diet, or treatment may start with a period of rest where you eat nothing by mouth, then start with clear liquids and then move to a low-fiber diet until your condition improves. More-severe cases typically require hospitalization.
A number of published reports have documented a successful treatment of colonoscopic injuries without surgery19, 20. Non operative treatment involves hospitalization, intestinal rest and intravenous fluids and antibiotics to contain peritonitis and allow the perforation to seal21.
, it can lead to an infection (called peritonitis). The infection can enter the blood and may cause a widespread infection of the blood (called septic shock). A bowel perforation is a serious condition that needs to be treated right away.
The most common site of colonic perforation is the rectosigmoid colon[1-4,17,19,20]. Several factors making this bowel segment vulnerable to being injured include a sharp angulation at either the rectosigmoid junction or the sigmoid-descending colon junction, and the great mobility of the sigmoid colon.