By Ritha Belizaire, MD, FACS, FASCRS | Board-Certified General and Colorectal Surgeon

Quick Insights

Diverticulitis happens when small pouches in the wall of the colon become inflamed or infected. Most episodes get better without surgery. Surgery is recommended when diverticulitis causes complications or keeps disrupting your life. The old rule of 'surgery after 2 attacks' is outdated. Today, the decision is based on you, not a number.

Key Takeaways

• Most people never have a second episode. About 1 in 6 do after a first mild attack.
• A repeat attack that turns severe is uncommon.
• Some people with mild diverticulitis don't even need antibiotics.
• Surgery is typically recommended for complications such as a fistula, a narrowing, or a blockage.
• When surgery is needed, a minimally invasive approach is preferred.

Diverticulosis vs. Diverticulitis

• Diverticulosis: small pouches (diverticula) in the colon wall. Very common after age 50 and usually causes no symptoms.
• Diverticulitis: one or more pouches become inflamed or infected, causing pain, usually in the lower left belly.

Symptoms

• Pain in the lower left abdomen that lasts more than a few hours
• Fever or chills
• Nausea or loss of appetite
• Constipation or diarrhea
• Pain or burning with urination, or air or stool in the urine (a sign of a fistula to the bladder)

Go to an emergency room for severe pain, a rigid belly, high fever, or vomiting that won't stop.

Diagnosis

A CT scan is the best test to confirm diverticulitis and check for complications such as an abscess. After an episode, especially a complicated one, I recommend a colonoscopy if you haven't had one recently, to make sure nothing else, like cancer, is being mistaken for diverticulitis.

Treatment Without Surgery

• Mild (uncomplicated) diverticulitis: rest, a liquid or soft diet for a few days, and pain control. According to American Society of Colon and Rectal Surgeons (ASCRS) guidelines, selected patients can safely recover without antibiotics.
• Abscess: a small abscess often heals with IV antibiotics. A larger one (over about 3 cm) is usually drained with a small tube placed by a radiologist.

When Is Surgery Recommended?

ASCRS guidelines recommend that the decision about surgery after mild diverticulitis be individualized. I consider:

• How often flares happen and how severe they are
• How much they disrupt your work, travel, and family life
• Ongoing symptoms between flares (sometimes called smoldering diverticulitis)
• Your overall health and immune system

Surgery is typically recommended when diverticulitis causes:

• A fistula, such as a connection to the bladder or vagina
• A stricture (narrowing) or a blockage
• An abscess that needed treatment, once you've recovered

Emergency surgery is needed for a perforation with widespread infection.

What the Surgery Involves

The most common operation is a sigmoid colectomy, which removes the diseased part of the colon and reconnects the healthy ends. I usually perform this robotically through small incisions, which ASCRS guidelines prefer when the expertise is available. Most patients go home in a few days.

In an emergency, a Hartmann's procedure may be needed. The diseased colon is removed and a temporary colostomy is created. Planning surgery before an emergency lowers the chance of needing a colostomy. See my ostomy page if you already have one and want to know about reversal.

Can I Prevent Another Flare?

• Eat a high-fiber diet with plenty of fruits, vegetables, and whole grains
• Stay active and keep a healthy weight
• Don't smoke
• You don't need to avoid nuts, seeds, or popcorn. A large study found they do not increase risk.

Schedule a Consultation

If you're dealing with any of these symptoms, you don't have to wait. Call my Houston office at 832-979-5670 to request a same-day or next-day appointment. My office is at 427 W. 20th Street, Suite 710, in Houston Heights, and I operate at several hospitals across Houston.

Medical Disclaimer

This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always talk with your physician about your own situation.

Frequently Asked Questions

Do I need surgery after 2 episodes of diverticulitis?

Not automatically. That rule is outdated. The decision depends on your symptoms, how flares affect your life, complications, and your health.

Will I need a colostomy?

Most planned diverticulitis operations reconnect the colon without a colostomy. Colostomies are more common in emergency surgery.

How long is recovery after diverticulitis surgery?

With minimally invasive surgery, most patients leave the hospital in a few days and return to most activities within about 4 to 6 weeks.

Can diverticulitis come back after surgery?

It can, but it's uncommon after the diseased segment is fully removed.