Treatment for diverticular disease of colon

Diverticulosis is generally discovered through one of the following examinations for appropriate treatment

Barium enema: This x-ray test involves injection of liquid material into the colon through a tube inserted in the rectum. The x-ray image shows the anatomy of the colon, and can identify if diverticula, large polyps or growths are present.

Colonoscopy: This test uses a thin, flexible tube with a light and camera to view the inside of the colon. Diverticula as well as polyps and other growths can be seen with this instrument.

CT scan: This x-ray test takes multiple cross section pictures of the body. It is not generally performed to make a diagnosis of diverticulosis, but this type of exam may identify diverticula.

Patients with diverticular disease should be counselled on the benefits of a high fibre diet. Bulking agents and laxatives could also be added until stools are soft and defaecation is painless.

Patients with acute diverticulitis are admitted to hospital for bed rest, nil by mouth (with iv fluids), analgesics, and IV antibiotics (e.g. cefuroxime and metronidazole). Patients presenting with PR bleeding are resuscitated and given blood transfusion.

Complicated disease (perforation, abscess, multiple attacks, uncontrollable bleeding) usually requires surgery to remove the diseased segment of colon. There are various surgical techniques available depending on the site of the disease, and a temporary stoma is usually needed (a "stoma bag"), although this is reversed after around 6 weeks.

CONSERVATIVE MANAGEMENT

Patients with acute diverticulitis are admitted to hospital for bed rest, nil by mouth (with iv fluids), analgesics, and IV antibiotics (e.g. cefuroxime and metronidazole). Patients presenting with PR bleeding are resuscitated and given blood transfusion.

Complicated disease (perforation, abscess, multiple attacks, uncontrollable bleeding) usually requires surgery to remove the diseased segment of colon. 

There are various surgical techniques available depending on the site of the disease, and a temporary stoma is usually needed (a "stoma bag"), although this is reversed after around 6 weeks.

SURGICAL TREATMENT

INDICATIONS :Recurrent attacks -and Complications

OPERATIVE PROCEDURES 

IDEAL OPERATION 

This is a one stage resection ,which involves removal of affected segment 10 - 20 cm long and restoration of continuity by end-to-end anastomosis .

IN CASES OF OBSTRUCTION & INFLAMMATORY EDEMA AND ADHESIONS a preliminary transverse colostomy can be done as a first stage. In second stage of resecion is performed after 3 weeks or later when inflammation has subsided.Colostomy is closed after a further 2 weeks.
IN ACUTE PERFORATION proximal colostomy can be done ,Exteriorization , Primary resection.

HARTMANN'S OPERATION colostomy after excision with closure of defunctioned distal bowel .

Restoration of bowel continuity can be done at a later stage by means of stapling guns .

IN FISTULA resection of diseased bowel. ,closure of fistula .

IN HAEMORRAHAGE resection of bleeding segment ...... read more