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Diverticulitis

good day everyone!:D

[am not sure if there's any thread talking about this illness already, so pakituro nalang sakin pag meron po.. thanks!]

last week, my brother in law suffered severe diarrhea and constipation and was dehydrated. he was given iv fluids in a clinic, but he lost too much fluids because of the diarrhea, so he was hospitalized. it was there that he was diagnosed with diverticulitis. he was treated with iv antibiotics and he responded well to it. in a few days, the infection subsided and he was (i guess) cured. the doctor, who was japanese (because this happened in japan), did not require him to undergo surgery since the infection was already taken cared of. he was discharged from the facility and given take home medications and was advised to increase fiber intake as a dietary modification.

the problem: his family is panicking, saying that his condition needs immediate surgery. does it?
does this condition recur? if so, how often?

though i read that there are some cases that needs such action, patients who respond well to medications do not need surgery.

any thoughts from those who really know? it would be very much appreciated:)

thanks in advance.

Comments

  • LesLes PEx Veteran ⭐⭐
    the problem: his family is panicking, saying that his condition needs immediate surgery. does it?

    How did his family come to this conclusion?

    Diverticulitis can either be managed conservatively (medications, bowel rest, etc.) or surgically. Most of the time patients will respond to conservative management. Only 15-25% of patients presenting with a first episode of acute diverticulitis have complicated disease that requires surgery. In other words, 75-85% of patients presenting with diverticulitis will NOT require surgery.
    does this condition recur? if so, how often?

    Diverticulitis can recur.

    * An estimated 20-35% of patients with conservatively managed diverticulitis experience a recurrence. One study of 252 conservatively managed patients reported a 50% recurrence of any symptoms in 7 years; however, only 8% of those required surgery for complicated disease. By 13 years, surgery had been performed in 14%. The mortality rate from complications in recurrent disease, of those initially treated conservatively, in this small study was 1%.

    * A different retrospective review of 337 patients hospitalized for complicated diverticular disease revealed mortality and perforation significantly associated with no prior history of diverticulitis or on first presentation. The same review of 337 patients revealed that 53% of patients with complicated diverticulitis presented on a first event. Of the 47% with recurrent complicated diverticulitis, 22% had 1 prior episode, 14% had 2 prior episodes, and 10% had 3 or more episodes.

    (These morbidity and mortality data, as well as recurrence rates, are based on a retrospective review of relatively short-term data).

    Instead of worrying about recurrence, your brother-in-law should focus on preventing a second episode. Risk factors for diverticulitis include:

    * Low-fiber diet is the highest risk factor. Common in industrialized nations, a low-fiber diet forms low-bulk stool that lead to increased segmentation of the colon during propulsion, causing increased intraluminal pressure and formation of diverticula.

    * High fat and beef diets also cause diverticular disease, probably for the same reasons as above.

    * Genetic causes exist. Asians have right-sided diverticula preponderance. In westerners, diverticula develop mostly on the left side.

    * Aging leads to change in collagen structure, such as increased cross-linking and acid solubility.

    * Corticosteroids but not nonsteroidal anti-inflammatory therapy have recently been shown to increase the risk of diverticulitis.

    Since aging and genetics are non-modifiable risk factors, the best way to avoid recurrence of diverticulitis is diet modification. His diet should be rich in fiber, and a high fat/beef diet should be avoided.
  • Les wrote: »
    How did his family come to this conclusion?

    well, they asked some relatives and other doctors about this case and these people said that it really needs surgery.
    i'm not too convinced with that, though:D

    thanks po..
  • LesLes PEx Veteran ⭐⭐
    One rule in medicine is that unless you've examined the patient personally and know his or her history, results of laboratory exams, etc., it's difficult to make conclusions. Little details can make big differences when it comes to management, e.g the choice of drugs used, choice of a surgical technique, etc.

    If there are any doubts about the initial management, it is best to seek a second opinion, rather than speculate and cause undue worry for the patient's family and friends.
  • thanks so much!

    i already told them that. since the japanese doc was the one with him during his confinement, he was able assess him and perform certain diagnostics that we do not know coz we aren't there.

    thanks again.
  • With diverticulitis there is bleeding from the large intestine.

    No blood on the stool, no worry.

    The symptoms may be similar to polyps on the large intestine, but still no bleeding here.

    This operation is not life threatening, and it involves removing the affected portion and then joining the remaining ends together.

    It does affect the diet of the patient after the operation.:)
  • thanks, c_a..
    i wasn't worried about hematochezia though.. i just want to make sure that diverticulitis does not always require surgery.;)
  • cool_ambo wrote: »
    With diverticulitis there is bleeding from the large intestine.

    No blood on the stool, no worry.

    The symptoms may be similar to polyps on the large intestine, but still no bleeding here.

    This operation is not life threatening, and it involves removing the affected portion and then joining the remaining ends together.

    It does affect the diet of the patient after the operation.:)

    Aba, hanggang dito napalaot ka Pare. At pati diverticulitis ay iyon kinukulatis!:lol:
  • *up*
    well, you see.. my brother in law, he was discharged from the hospital since he was asymptomatic and his white blood cell count normalized. when he got back to work,(about 2-3 days after)the low grade fever returned again, as well as the abdominal pain and the elevated WBCs.

    with his infection/inflammation recurring that fast, almost instantly.. does that mean that he needs immediate surgery?

    thanks again. :)
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