Sep 9, 2015 — Abdominal pain, bloating and gas can be caused by any number of problems, but diverticulitis is a common source of those symptoms. It’s an infection of the large intestine that can cause mild to severe pain, particularly in the lower left part of the abdomen. In this podcast, Dr. Tom Miller and Dr. Bartley Pickron discuss when you should see your physician and what they can do to treat the infection and alleviate your pain.

Interview

Dr. Miller: Diverticulitis. What is it, how do you know if you have it, and would you ever need surgery for it? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists, with Dr. Tom Miller, is on The Scope.

Dr. Miller: I'm here with Dr. Bartley Pickron. He is a surgeon and also specializes in colorectal surgery. He's a professor of surgery here at the University of Utah. Tell us, what is diverticulitis? How would a person know if they had that?

Dr. Pickron: Well, diverticulitis is an infection of the colon. It usually comes from infected diverticula, which are little pouches in the colon.

Dr. Miller: So when a person develops an inflammation due to an infection, what do they feel, or how do they know they might have an infection of the colon?

Dr. Pickron: The majority of the time, it starts out with pain, usually in the left side, down toward the pelvis, and the pain usually comes on pretty quickly. They usually may have fever, not much of an appetite, and just generally don't feel good.

Dr. Miller: And when should they, if they experience that, head to the doctor in your opinion?

Dr. Pickron: Well, if it's the first time, then you should really get checked out within the next couple of days. The majority of people take a week's course of antibiotics and they do well, and most people never have a problem again.

Dr. Miller: Would one ever need surgery for this? Does it ever get so bad that you would need to have part of the colon taken out where the infection occurs?

Dr. Pickron: Well, it certainly can. I mean, some people have their first episode is a free perforation, which is a life-threatening condition.

Dr. Miller: Now, perforation is described as . . .

Dr. Pickron: Basically a hole erupts in the colon.

Dr. Miller: And it leads to leakage . . .

Dr. Pickron: Leakage of stool into the abdominal cavity.

Dr. Miller: Not a good thing.

Dr. Pickron: Not good at all. And so, like I said, that's usually a life-threatening condition that has to be taken care of with emergent surgery.

Dr. Miller: What do you talk to the patient about in terms of surgical intervention?

Dr. Pickron: Well, it really depends on their symptoms. A lot of the recommendations for this disease process have changed over the last five to 10 years. And so what we are really looking at now for people who require surgery are not really the number of episodes you've had per se, but more of the people who get an episode and really never recover from it. Just have this kind of lingering left-sided pain, and just general GI discomfort.

Dr. Miller: That continues even after a course of antibiotics?

Dr. Pickron: Usually after multiple courses of antibiotics.

Dr. Miller: So then, it's time to take out part of the colon, I guess?

Dr. Pickron: Right.

Dr. Miller: And how much of the colon do you usually remove in order to repair this problem?

Dr. Pickron: I mean, on average, it tends to be anywhere from 8 to 12 inches. It really depends on the extent of the inflammation that's present compared to the healthy colon that's left, that's not involved.

Dr. Miller: And how do you do the surgery now? I understand that it's probably done laparoscopically?

Dr. Pickron: Yeah, so we have some good minimally invasive options for this. Usually, we start out with a little quarter of an inch incision in the belly button, and we're able to put a camera into the abdominal cavity and take a look around and really see where the problem lies. Then we usually make about a two-inch incision kind of just above the bikini line, and we're able to do the entire surgery through that.

Dr. Miller: So not a large incision as in the old days?

Dr. Pickron: Not at all. You can still wear your speedo if you want to.

Dr. Miller: That would be great, so . . . maybe not for me. How long does a patient plan to be off work for this, or how long can they expect the recovery to take?

Dr. Pickron: Well, a typical hospital stay is anywhere from two to four days. And then, overall recovery, kind of depending on the fitness of the patient prior to surgery, is usually anywhere from three to six weeks.

Dr. Miller: I have heard that after an episode of diverticulitis, patients have been told not to eat popcorn, or jam with seeds in it. Can you comment on that? I'm not so sure that isn't a myth.

Dr. Pickron: It is a myth and it used to be the theory that plugging these little pockets makes diverticulosis turn into diverticulitis and so the theory used to be that if you ate nuts, popcorns, or seeds that you would plug these little pockets, but there's really no scientific evidence that shows that's true. And actually, these foods are all very good fiber sources, which can actually help with the progression of diverticulitis.

Dr. Miller: So in general, you would tell patients after a bout of diverticulitis to increase fiber in their diet?

Dr. Pickron: In the acute setting, to kind of tone it down a little bit, but once they've recovered, then, yes, about 20, 25 grams a day.

Dr. Miller: So it sounds like if one has diverticulitis and it's not too severe, you're going to have that treated by your primary care physician, usually with antibiotics and rest, and then if it recurs or if it continues, if there are multiple episodes or whether it's a continuous rather nagging pain after multiple courses of antibiotics, you would recommend that the person see a surgeon, and preferably perhaps a colorectal surgeon?

Dr. Pickron: Absolutely.

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