Emergency surgery and large doses of antibiotics are usually needed to treat perforated diverticulitis. During surgery, the abdominal cavity will need to be washed clean of the intestinal fluids leaked from the colon in a process called peritoneal lavage. Surgical treatment of perforated diverticulitis requires several procedures including primary colon resection, primary anastomosis, or a colostomy.
After arriving at a hospital, intravenous (IV) fluids and broad-spectrum antibiotics will be started right away. The attending physician may order a computerized tomography (CT) scan or a magnetic resonance imaging (MRI) scan to visualize the contents of the abdomen. If a patient is suspected to have a large perforation, the scan may be skipped in favor of exploratory surgery.
The first step in surgery for perforated diverticulitis involves a primary resection of the colon. An incision will be made in the abdomen to expose the colon. Damaged areas are then excised from the length of the colon, leaving only healthy tissue.
Segments of the healthy colon tissue are matched up and sutured together in a process called primary anastomosis. This technique requires the surgeon to carefully preserve the hollow structure of the intestines. Anastomosis connects the free ends of the colon to enable future bowel function.
If the patient’s colon is not healthy enough to reattach to the rectum, the surgeon may decide to create a colostomy. One end of the colon is threaded through an opening in the wall of the abdomen, and then is sutured to the abdominal skin. A drain may be inserted in the abdomen to remove pus and other infectious fluids during the recovery period.
Peritoneal lavage is the next step in the surgical treatment for perforated diverticulitis. The inside of the abdominal cavity and the internal organs are literally washed clean of the leaked bowel contents. Once the abdomen has been cleansed, the surgical incision will be closed with staples or sutures.
After the surgery, an in-patient hospital stay will be required until the colon is healthy enough that another perforation is no longer a concern. If a colostomy was needed, a bag will be attached to the stoma, or opening, in order to collect fecal matter produced by the body. During this time, a CT or MRI scan will be repeated to evaluate the healing process and look for any abscesses, or pockets of infection.
Six months after the primary resection and colostomy, the surgeon may be able to reattach the end of the colon to the rectum if the tissue is healthy enough. The decision will be made after a series of tests are performed, including a colonoscopy. A colostomy reversal procedure closes the hole in the abdomen and restores the normal bowel elimination process.
