Intestinal diverticula / diverticulitis are formations like “pouches” that hang on the outside of the intestine but communicate with its lumen, which is why they are recognized during colonoscopy by the holes they create inside the intestine.

“The presence of diverticula is very common in the general population, however, the vast majority of patients live without symptoms, perhaps for their entire lives,” points out Ms. Eleni Karafoka – Black Surgeon, Director of the 2nd Clinic of Robotic Surgery and Surgical Oncology at Metropolitan General.

What is diverticulitis?

Due to their shape and location, diverticula retain fecal material, which creates ideal conditions for the “overgrowth” of microbes. Diverticulitis is the result of inflammation of a diverticulum. In typical cases, it starts with mild pain located in the left lower part of the abdomen, which becomes stronger as the inflammation progresses. Then fever and nausea are added to the symptoms, while the elimination of gas and feces stops.

What are the complications of diverticulitis?

In the majority of cases, an attack of acute diverticulitis can be effectively treated and resolve without any further consequences for the patient. In a small percentage, however, direct or distant effects – complications – may appear along the way.

“In the event that an acute diverticulitis has not been effectively treated with conservative treatment, or has not been treated at all, there is a high probability of perforation of the inflamed diverticula, resulting in the creation of a local abscess or progression to severe peritonitis with very serious consequences.

However, even if the acute phase is treated effectively, there is always the possibility of a narrowing of the sigmoid leading to severe constipation, or even worse, of a fistula (communication) with a nearby organ, more often with the bladder. In this case, the patient notices bubbles with air in the urine (pneumaturia) while suffering from recurrent urinary tract infections from colibacter”, emphasizes the specialist.

Are there special tests to diagnose diverticulitis?

The test of choice for diagnosing diverticulitis is colonoscopy. This examination should not be performed in the acute phase of inflammation to avoid the risk of iatrogenic bowel perforation. At this stage the test of choice is the CT scan. If the test is performed in the hospital while the patient is hospitalized, oral gastrografin can and should be given to identify possible free perforation of the diverticulum and leakage of contrast material into the abdomen.

How is diverticulitis treated?

In the early stages, the patient is admitted to the hospital and begins intravenous treatment with two or three antibiotic drugs. Usually the symptoms calm down and the inflammation stops after 4-5 doses of medicine. In case the inflammation progresses and results in perforation with peritonitis, the patient is urgently taken to the operating room. The operation performed in all cases is called Sigmoidectomy, i.e. removal of the Sigmoid.
25% of those hospitalized require surgery in their first hospitalization. 1/3 of patients treated with drugs relapse within the next five years.

When is a patient operated on?

If a patient has a history of more than two serious attacks of diverticulitis requiring hospitalization, surgical removal of the sigmoid is recommended to prevent the worst and cure the patient for life. This surgery has special requirements especially if there have been previous inflammations.

The modern line in most specialized clinics dealing with diseases of the colon and rectum, is the minimally invasive approach to all benign bowel diseases, such as diverticulitis.

“The most modern method of treating the disease with DaVinci Robotic Surgery facilitates the surgery and achieves the best possible result.

3D vision and modular tools give the robotic surgeon a technical edge. In surgeries like this one, in which delicate and non-traumatic manipulations are required, as well as safe recognition of anatomical elements to avoid injuries, the surgical robot finds its perfect application and in experienced hands it can and does make a difference”, explains Mrs. Eleni Karafoka – Black. “In easier cases, the surgery can also be done laparoscopically with excellent results,” he concludes.