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The large intestine wall has three layers. The innermost mucosa allows the absorption of water in the stool. The musculature in the middle section ensures that the intestinal contents are pushed forward with coordinated movements. It is surrounded by a sheet of peritoneum at the outermost part. As the age progresses, especially from the age of 40, the mucous comes out from the weakened muscle tissues and forms pockets like buds. This formation is called a diverticulum and may be found in large numbers. Although these diverticula can be located in the entire colon, they are most often located in the descending colon and sigmoid colon, that is, in the parts of the colon on the left side of the body. Most of the time, they can be detected in colonoscopic examinations for control purposes and do not require treatment at this stage. When patients begin to experience problems due to diverticulum, treatment is required.
Diverticulum are pockets that are in contact with the inside of the large intestine with a narrow neck. Patients may experience two types of problems with these structures.
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Bleeding. The blood vessels in the mucous membrane inside the diverticulum can cause bleeding due to irritation. Although these bleedings can be severe from time to time, they mostly tend to stop spontaneously and stop with supportive treatment (given blood, etc.). In rare cases, persistent bleeding that does not stop may require surgical treatment. In surgical treatment, the colon area with the bleeding diverticulum is removed, and the remaining intestinal ends are stitched together.
2. Diverticulitis. If the small necks where the diverticulum opens into the large intestine are clogged with fecal residues, the small amount of secretion made by the mucous membrane inside the diverticulum accumulates as it cannot empty into the intestine and causes the diverticula to swell and then become inflamed. This condition is called diverticulitis. If enough time passes without treatment, the swollen and inflamed diverticula may perforate due to pressure and cause abscess formation in the abdomen or around the intestines. This condition requires treatment. If there is no perforation and the diverticulitis attack is the first time, the patient can be cured with antibiotic therapy. If a perforation has developed and a limited abscess has formed, antibiotic treatment alone is usually sufficient. If the intestinal contents flow into the abdomen uncontrollably after the puncture, then this fluid flowing inside will need to be removed from the abdomen with a surgical intervention. For this, a drain (tube) is placed in the area with the closed surgical method called laparoscopy and the inflammation is taken under control by taking the fluid out. Antibiotic treatment should also be added to this surgery.
Diverticulitis does not cause cancer.
If an attack of diverticulitis has occurred more than once, it means that that area of the large intestine is now diseased and not functioning. Diseased tissue must be removed. This surgery is usually performed with the laparoscopic (closed) method (for technical reasons, the open method can be turned), the diseased large intestine is removed, the remaining intestinal ends are stitched together to ensure intestinal continuity.
After such surgeries, patients spend about a week in the hospital. If they have problems after the surgery, this period may be longer. Depending on the general condition of the patient and his current diseases, the need for intensive care may occur after the operation.
After the operations, bleeding, lung problems or anesthesia problems that can be seen after every operation can be seen, as well as problems specific to this surgery. The most important possible problem is leakage from the suture line between the intestinal ends that are sewn together. These leaks may contaminate the abdomen and cause intra-abdominal and general body infections. If it is detected, it is necessary to separate the two intestines sewn together and connect the upper end to the bag by mouthing it to the abdominal wall. The bottom end is closed. After the infection passes and the patient recovers in a few months, this bag is closed and the intestines are reconnected.