One in two people over the age of 50 has protrusions in the intestinal wall, known as diverticula. At the moment, however, there is a clear tendency that the affected people are getting younger and younger (already from the age of 30). year of life).
Contribution by Chief Physician Dr. med. Michael Zitzelsberger, Department of General and Visceral Surgery / Proctology at Vilshofen Hospital
This disease of the large intestine, medically known as Diverticulosis or, in its inflamed form, is known as Diverticulitis, is about to become one of the most common diseases of civilization in the western world. Approximately 80% of these diseases can be treated conservatively / medicinally. However, in one in five of those affected, surgery is also a possibility. In the following, this is discussed from the perspective of an experienced general abdominal surgeon-. Visceral surgery at the hospital Vilshofen more exactly reported.
Origin of the disease
In contrast to the diet in many poorer regions of the world, our western/modern food intake is characterized by relatively high proportions of meat and carbohydrates (bread and cookies), which is also referred to as a low-fiber diet. The following diagram is intended to illustrate the purpose of the large intestine for us and why diverticula are formed, also known as wear or overload symptoms of this organ could be called.
The natural process of stool thickening (red waves, arrows and large circle). Diverticula = small black circles. Perforation = small red circle. (Graphic: msd.de)
With the intake of food and admixture of different digestive juices we accumulate about eight liters of fluid per day in the small intestine. If we were to end up at the transition from the small intestine to the large intestine, there would be a water loss of these eight liters of intestinal contents. Since our body consists of 60% water, we can not afford such a loss. The large intestine, among other functions, is now mainly responsible for recovering this water, which is called reabsorption. The first part of the large intestine still transports a lot of liquid stool (red waves), which causes little difficulty in terms of forward transport.
This transport happens because the intestinal musculature contracts in a ring-like manner in sections, while adjacent sections remain loose and can thus absorb the stool in portions. Then this next part of the intestine contracts and so it moves toward the exit, much like a peeping caterpillar moves along. As the stool approaches the exit, the thicker the Stool consistency and sometimes it is indeed the case that it resembles pebbles more than soft stool.
The part of the large intestine located on the left side of the abdomen has the most work to do and must also exert very high preres for forward transport. Just as the intestine presses on the stool, the latter presses on the biomechanically soft organ intestinal wall back. At the points where the blood vessels for nourishing the mucosa pass through the musculature as in small wall openings, the muscle layer then separates and the mucosa bursts through, which then protrudes to the outside like a bubble gum bubble, as is known from children. The normally two-layered intestinal wall then becomes single-layered at these points. Leakage of stool into the abdominal cavity. Leading to peritonitis.
On the other hand, stool containing bacteria remains in the blisters, leading to Inflammations in the affected section of the intestine. This is then called diverticulitis.
In one in five affected patients, the disease can now develop into a chronic = relapsing form of the disease, which is then referred to as chronic recurrent diverticulitis denotes. Such episodes can occur at intervals of several years, but sometimes already at intervals of several weeks or months. These episodes are characterized by more or less severe abdominal pain with fever.
Due to a permanently too high prere in the intestine, the intestinal wall can bulge outwards and becomes thinner at these points. In the worst case these areas can burst, similar to chewing gum. (Photo: Akova/Adobe Stock)
Therapy: Conservative vs. surgical
While intestinal perforation always leads to emergency surgery with abdominal incision and creation of a temporary, artificial bowel outlet, acute diverticulitis is initially treated conservatively with antibiotics treats. However, this usually means a hospital stay of several days. In selected mild courses, outpatient antibiotic treatment in tablet form may also be sufficient.
If several such episodes have occurred, it may well be that a patient is recommended to have this chronically scarred part of the colon removed as a preventive measure. Also in the case of so-called covered perforations or in conditions with the appearance of an encapsulated abscess in the abdomen, one recommends the preventive surgery (resection). These operations always take place when the inflammation has healed and the patient is actually well, even symptom-free.
Some people ask themselves: "Why do they want to operate on me only now, when I am doing well, and not back then, when I could hardly hold myself up because of the pain?? " This has simply. Poignant technical reasons. When you take out a piece of casing, you also have to sew the casing back together again. To do this, the surgeon needs a bowel wall that is strong and stable so that the sutures will hold, otherwise the problem arises again that the bowel will leak if the sutures tear out because the tie is too weak. Thus, this preventive bowel surgery always works best when there is no inflammation, the patient is symptom-free, the inflammation values are normal and a colonoscopy has previously ruled out a malignant disease of the colon.
State-of-the-art video technology
To ensure that this planned, but by no means risk-free colon surgery is a success, the team at the Vilshofen Hospital uses state-of-the-art technology. The operation takes place minimally invasive (keyhole surgery), in which the abdomen is only cut open enough for the affected piece of intestine to fit through. But that can still be eight to ten centimeters. In order to achieve an optimal solution, the best technically possible options are used for this purpose: HD- and 3D screens.
Not all people are the same, not all findings are the same, even if it is the same diagnosis. For example, in an outpatient consultation, experienced surgeons will work out an individually tailored solution for each person concerned.