Hey. This is Dr. Buck Parker. I am a board certified general surgeon.
In this video, we’re gonna talk about diverticulitis. A lot of people always ask me, “What is diverticulitis?” A lot of patients come in, they have diverticulitis. They never heard of it, they wanna know what it is, and they’re a little confused about things. So this video, we’re gonna go over diverticulitis.
Definition. First of all, we’re gonna take a little anatomy lesson as usual. Okay, so this is…You can’t see that. Right there. This is a crude drawing of the colon. The colon is the portion of the bowels, the last portion of the bowels, which basically…I’m gonna draw this little thing here…Which moves the liquid stool, which comes into here. This is the small bowel, goes into what we call the sigmoid and then goes up the ascending colon across the transverse colon and down the descending colon, along the sigmoid colon because it’s shaped like an ‘s’, and then out the rectum. That would be the anus down there.
Basically, the colon removes a lot of water from the stool that comes in liquid here. This part here. And then it’s liquid and the water gets removed, some electrolytes get removed, and then it becomes solid somewhere over here. And then it goes out the infamous poop shoot down there.
What happens with diverticulitis. You ever seen a little inner tube? The inner tube gets a little weak spot in it. You have the little blip. I’m gonna- Just gonna draw it right here. This is what happens. You see this little blip right here? Over there. The wall of the colon basically gets a weak spot. You have a little out-pouching. A little bubble. That’s a diverticulum. Diverticulae with a A-E is singular. Diverticulum, actually, that’s singular too. Diverticulitis, that’s not singular. I wonder what is multiple. Diverticulae, I think, is maybe…I don’t know. Anyway, here we go. There’s lots of them over here and, generally, they happen in the sigmoid colon like this. Sometimes it could happen in the ascending colon. I’m gonna talk about the ones here. We’ll talk about the ones here in a second. When these little things here…They can happen- Generally, maybe you have some pain for a shorter period of time. You have more of those things, blips, develop. They can do nothing. They can just sit there all the time, and you can never have any problems with it. Or what could happen is they get blocked. I’m gonna put it on my infamous little drawing here. See the neck of them, or the base of those things? They’re blocked off.
What is in the colon besides poop? Bacteria. Bacteria gets in these things, and they get trapped. There’s no place to go. Then bacteria does what they do best and proliferate. Then we have a little thing there. The thing there, it bursts. Or it gets- It actually has micro perforations, and that is diverticulitis.
ITS means information. Diveritculitis is when you have a diverticulum. Diverticulum by themselves are not infected. They can be not infected. Then you can have a diverticulitis, which is infected. You can have- Usually, just one gets infected. You have micro perforations and then we have a little bit of a continuum, what we talked about last time from say diver…So you have micro. If I was good, I would’ve done this before. Perforation to gross rupture. Once again, we have a continuum. Something like this.
We have…Where are we? Micro perforation. You can’t even read that ’cause I have terrible handwriting. Then on this little continuum here, we have gross perforation or gross rupture of the colon. That would be where you just have a big old hole. You just have a big old blowout. You know what I’m saying? You have a big blowout like that, and you just have stool spill into the abdomen. Bad news. If you couldn’t guess that. In the meantime, we have maybe a little bit of spillage but not a lot and we can form what’s called an abscess.
An abscess is something like this where you have a micro perforation like this or a small blowout and the body walls it off. All this stuff in here is bacteria. Bacteria gets caught in there, but the body contains it. It doesn’t go everywhere. You can get fevers and chills and get sick, but that is part of the continuum. I just wanna get that little definition there. Then we’ll talk about the symptoms and things.
Diverticulitis is basically an infection of the colon but after you have these little diverticulae that get ruptured, you can have micro perforation, you can have a small- slightly bigger perforation with abscess where you have gross rupture. Most of the time, you have this micro perforation, which is treated with antibiotics. I’ll go over that in a second.
Symptoms associated with diverticulitis are pain, abdominal pain, and most of the time…If I go like this, this is the left side and this is the right side. Most of the diverticulitis happens on the left side. You can have it over here. It’s just not very common. You can have diverticulae over here. They’re less common. Mostly, the diverticulae over here bleed. We generally talk about diverticulitis. We talk about left side. Left-sided, lower abdominal pain is generally what’s going on down here. What’s the right side? Right side is appendicitis. We talk about right sideabdominal pain with fevers and chills. We generally think of appendicitis. Left side abdominal pain with fevers and chills, we generally think about diverticulitis.
If you have progressing abdominal pain maybe over 24, 48 hours which is not going away. Getting worse. Fevers and chills. You should probably go see somebody. If it’s real bad, you should see somebody in less than 24 hours. That’s generally what folks feel.
You can have some nausea and vomiting. You can have diarrhea. You can have constipation. Let me mention real quick. Why do we get these? It is essentially because the colon is having a lot of pressure. As you can imagine, the colon is kind of like a muscular tube, and it squeezes along the way like this. Squeezes everything down. If the squeeze generate too much pressure in the colon, then you can have- That’s just like the weakening of the tubenator tube. The wall…There’s certain parts of the colon where the wall is a little bit weaker and that’s where you have those little out-pouches.
I lost my train of thought. What was I gonna…?
Symptoms. Fevers, chills, nausea, vomiting, diarrhea, constipation, either one.
Physical exam. We’re gonna talk about physical exam. Same thing. When you go to the doctor and they press on your belly…If they press over here, it doesn’t here and it’s the right side and they press over here and you’re like, “Oh, that hurts.” Then it may be some diverticulitis. It may be micro perforation. If they push over here and it hurts over here, that may be a gross rupture that’s called peritonitis, and that’s because inside of the abdominal wall, the lining is really, really angry. No matter where you push, it hurts over here. That’s, basically, physical exam.
The laboratory values. Generally, patients have a elevated white blood cell count, and that is because the white blood cells are trying to fight some sort of infection, and you have a rise of white blood cells in the blood and so your doctor will probably get you that. Typically, it doesn’t affect the blood so your hemoglobin or your e-ma-di-crat doesn’t really get infected. However, if you have a right-sided diverticulitis, excuse me, a right-sided diverticulum over here, those often bleed more than they get infected. So sometimes you have gross blood from the rectum, then you may have a diverticulum that is bleeding.
X-rays. I got my cheat sheet here. X-rays, typically, how it’s diagnosed…If you have abdominal pain and you go see your family physician or you go to the emergency department, generally you get just a plain X-ray. It looks from back to front. You see the bones and all that stuff. You may see some gas. But you don’t see, really, the diverticulum or the infection so much.
The CAT scan is much better with that. You can probably get a CAT scan. If you see nothing on the initial X-ray, get a CAT scan and that can show you the diverticulum. That’s the best way to- But, also, you’ll probably see diverticulum if you don’t have an infection. If you do have an infection, that’s the best way to see it. Diverticulitis. And also the abscess which we talked about.
And then treatment. There’s a few ways we can treat this depending on what is going on. If it’s a micro perforation and we don’t think there’s spillage of stool into the abdomen, there’s not an abscess, and it’s not gross spillage, then we can generally treat those with antibiotics. Sometimes you need a little bit of IV antibiotics. Say you stay in the hospital for 24 hours, you get the IV antibiotics, then you feel much better the next day. You go home and you stay on oral antibiotics for about eight to 14 days, depending on your severity.
If you have an abscess, that’s a little different. What we’ll do, depending on how big the abscess is…If it’s over two centimeters, you may stick…Maybe I shouldn’t say stick, but you put a needle – you place a needle, generally – into the abscess. This is done under radiologic guidance so you get a CAT scan or an ultrasound and you can put a needle through the skin after you numb the skin into the abscess and suck out the pus. Basically. That’s not the fancy way of saying it, but that’s what you do. You can get that – and sometimes you leave a drain, like a tube, in that cavity and sometimes you can suck out the pus and you don’t need to leave a drain. You would also get antibiotics for that, depending on how big the abscess is, depending on where it’s located and all that. You can have that done, and you may have antibiotics for two weeks to six weeks, depending on severity.
Lastly, is the surgical treatment. After you have an abscess or you have diverticulitis, if you have a little tiny diverticulitis where it’s a micro perforation, you get some antibiotics, it goes away, you feel good. It happens again. When you start having it happen more than once, then you start thinking about, well maybe you need that portion of the colon removed because if it perforates…Here’s the trick. Listen to this. If it perforates and you have gross contamination of stool in the abdomen, you may need an emergent surgery with a removal of that portion of the colon in a colostomy bag. Where you have the bag where you poop out of your skin into the bag. Bad news. Nobody wants that. That’s the big deal about diverticulitis. You have it recurrently, if you have an emergency surgery for it, you may need a colostomy bag.
We’re definitely- Surgeons, in general, are moving more towards not doing the bags so much and trying not to do that. But if it’s grossly infected, there’s lots of poop everywhere…If you do that and you close it all up, you could have a bad infection. So depending on the situation, you may end up with that. You may not, but that’s the bad stuff.
That was the emergency portion. If you have an emergency- If you have the gross rupture, you get real sick, you go in the hospital, you have an emergency surgery. On the elective side, say you get diverticulitis and it’s micro perforation so you get that a couple times. Your surgeon and/or doctor may recommend you have that portion of the colon out. I’m gonna draw this portion right here, which is generally the sigmoid portion, sigmoid colon right here with the little ‘s’ here. The little ‘s’ turn. That’s a sigmoid portion. So you get the portion of the colon and when your surgeon goes in there and you look for all these diverticulae and they say, “Well okay, there’s no diverticulae about right here. Let’s go here.” Generally, that’s about the sigmoid colon, and then you come down here and they say, “Okay, there’s no diverticulae here. This looks pretty good stuff. Down here, we’ll leave that. We’ll take this portion out.” Then if you have an elective surgery, you could put these back together and hook you back up with the same surgery. And you don’t have to have a colostomy bag. So that’s a good…
All right. That is my spiel on diverticulitis. I hope you liked that. I hope it makes a little bit more sense. I hope it helps you to avoid the colostomy bag ’cause nobody likes that.
You know where to find me, drbuckparker.com. I will see you later.
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