tag:blogger.com,1999:blog-30499448.post237714925284138481..comments2024-02-18T13:53:30.168-08:00Comments on Surgeonsblog: Ken's ColonSid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.comBlogger84125tag:blogger.com,1999:blog-30499448.post-58690051956250382082019-12-30T17:05:39.238-08:002019-12-30T17:05:39.238-08:00It would be removal of that segment of colon, the ...It would be removal of that segment of colon, the sigmoid (for S-shaped) colon. When done between attacks, when the infection is simmered down, it's almost always possible to sew the ends together without a colostomy. And losing that amount of colon, which is around one-fifth of the total length, has no long-term effects; i.e., bowel function would be expected to be normal after healing.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-24865599946292353812019-12-30T15:43:04.914-08:002019-12-30T15:43:04.914-08:00Thank you Dr. Sid. Would it be colon removal or so...Thank you Dr. Sid. Would it be colon removal or something less evasive?<br />Lady Dhttps://www.blogger.com/profile/04313010109082720444noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-45714194969787495552019-12-30T14:25:53.126-08:002019-12-30T14:25:53.126-08:00I try to avoid making specific recommendations or ...I try to avoid making specific recommendations or provide specific opinions in particular circumstances. What I can say is that, in general, when a person has had two or more episodes of diverticulitis severe enough to require hospitalization, they fall into a category where surgery is high on the list of options, and in which "lifestyle changes" might not do the trick. I'd also tell them that, with the disease mainly limited to the sigmoid colon, where it's most common, surgical removal has a high likelihood of permanent cure and a very low risk of postoperative problems.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-23262981302731854792019-12-30T11:42:51.019-08:002019-12-30T11:42:51.019-08:00Hello Sir, your blog is a breathe of fresh air. Af...Hello Sir, your blog is a breathe of fresh air. After scouring the internet for answers, it's nice to find a forum addressing my specific concerns by a medical professional. I am a 61 year old African American female. On October 9, 2019, I was traveling across country and I went to ER with severe abdominal pain. I was admitted for three days and treated with antibiotics through IV. I was released with 12 days oral meds of Cipro and Flagyl. A CT scan revealed sigmoid diverticulitis with abscess formation no bleeding, no diarrhea, no fever with some constipation. On November 11th, I reported back to the ER again with severe abdominal pain and again admitted, treated with IV antibiotics Sent home this time Amox-Clav. Since then I have had two mild flare-ups that were treated at home with antibiotics. I have pledged to change my lifestyle with a fiber-rich diet and exercise, but have had a chance with these back to back flare ups. A colonoscopy consult is scheduled for February. I don't know if I should wait or try to seek medical attention elsewhere to try and get in sooner. My question to you is, in your opinion do you think surgery is enviable as a result of the continued flare ups or is it possible it will resolve itself. <br /><br />Prior to these episodes, I have not had any kind of stomach issues expect when I was 17 I had a bowel obstruction (don't know all the details) this came from out of the blue after all these years. What a life changer one minute I'm traveling enjoying life and now this has stopped me in my tracks. Your response is greatly appreciated. Thank you so much.Lady Dhttps://www.blogger.com/profile/04313010109082720444noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-35577355054164798702017-10-28T07:04:36.051-07:002017-10-28T07:04:36.051-07:00Ms Isker: much as I'd like to help, I really c...Ms Isker: much as I'd like to help, I really can't offer much in your case. I'd need to be able to see your Xrays and other tests, and your records. Diverticular disease can cause bleeding, or infections with pain. Usually not both at the same time. It sounds like you've had both, but I hesitate to assume your problem is related to diverticulitis now, because I just don't have the information. If it's been confirmed that that's what's going on, and given the amount of trouble you're having, surgery seems high on the list of options. Your docs, and particularly your surgeon, are best able to address your concerns and answer your questions.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-43239786872506073262017-10-28T02:23:18.535-07:002017-10-28T02:23:18.535-07:00Hi I'm a 52 yr old female had my first diverti...Hi I'm a 52 yr old female had my first diverticulitis attack in Feb of 2015 w hemorrhaging which lasted all day until about 7 pm er visit antibiotics pain meds was ok for about a year within the last 9 months have had around 8 episodes of infection this last time the worst couldn't have a bowel movement despite taking mirilax and eating nothing but soup finally went a small amount few days later was on tolit 4 hours nothing in extreme pain 2 days later finally relief pain in lower left side went to dr who gave me flaygil and cipro took it all felt good few days less than a week later pain in my side again constipation despite eating mostly soup saw surgeon who decided surgery was best put in hospital on flaygil and cipro again ct again said no infection went home next day was in pain feeling very sick went back to er Sunday in pain that was more than a month ago as to initial pain scheduled for a colonoscopy Nov 7 surgery after I have been in constant excruciating pain since my infection began this time.no Pain meds due to causing constipation have tryed softeners eating not much analgesics don't help much constant pain after I BM it males it hurt worse am having pain on my right side now too feel nasty fever pain constant nothing seems to stop it not even bm I have a visit with the Dr for pre op colonoscopy for the 7 the my question is why am I having so much pain with no relief and why does it hurt after bm that are soft applying a heating pad made the pain almost unbearable called my clinic told to take miralax even though I said I'm not constipated or warm bath to ease pain none of it has worked what is your opinion as to what I should do I can see my surgeon on wed the 1 st should I wait until wed am confused because they didn't seem to get what I was saying about my pain am concerned about why so long and how much have had is some blood but not now.what is your take on it . Ann Iskerhttps://www.blogger.com/profile/01925938863826592970noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-65776678868020923862017-01-24T08:56:36.884-08:002017-01-24T08:56:36.884-08:00As I wrote, the decision to operate, and when, can...As I wrote, the decision to operate, and when, can be difficult, especially when there's no obvious emergency. Not knowing how much and which part was removed before, how much and which parts are left, I'm unable to comment on the "everything removed" question; besides which my purpose in writing here is to provide information (and good stories!); I really can't make specific suggestions or recommendations. <br /><br />For general information, I can say that diverticula don't involve the rectum; it's uncommon to remove the entire colon for diverticulitis, saving the rectum, but I've done it. Hooking the ileum to the rectum can avoid ileostomy and, especially for younger people, can result in more frequent than usual, but continent, bowel movements.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-16809360083462856152017-01-23T19:55:46.115-08:002017-01-23T19:55:46.115-08:00I could write for a week, and I am not sure I woul...I could write for a week, and I am not sure I would have covered all the details, but I will attempt to keep it short. <br /><br />15 years ago, I was diagnosed with diverticulitis. This is after having my appendix removed, and finding out it was perfectly healthy, and many (10+) hospital stays where they went back and forth between possible Chron's or Colitis. I must say I was 26 years old when I heard diverticulitis for the first time. The next few years were the same, a few hospital stays / year with antibiotics and I was on my way. In 2005, I was hospitalized 13 times between April and August. At this point I had antibiotics at home through IV, as they were attempting to clear infection for a scheduled surgery to remove the infected portions of my colon which was to happen in september. On August 3, I collapsed at home and was taken for Emergency surgery. I had a sub total colectomy, and had an ileostomy. I recovered well, and had reversal surgey 9 months later. <br /><br />It had been 10 years with 0 symptoms or limitations! I count my lucky stars every day as I nearly refused the reversal surgery. I may have had an ileostomy, but I was pain free and able to eat (no more feeding tubes)!!!<br /><br />I am now 41, and this past November, I started signs. The same pain and symptoms started, and though I immediately reverted to a liquid diet, I had to return to the ER with a fever and unbareable pain. A CT scan confirmed diverticulitis. I was put on IV antibiotics and 5 days later was able to leave the hospital with antibiotics. I remained on a liquid diet (knowing the symptoms all too well) as I had not yet worked my way up to transition to a low residue diet, and the infection returned again after 3 days of completing my dosage of 10 days of Flagyl and Cypro. This repeated itself times 2 since November. I will see a surgeon again on Feb 2 and if I have been symptom free long enough, he will do a scope. My questions are this, from your perspective, should I continue waiting? I will say my very first surgery happened because of a perforation. After 3 weeks in ICU I recovered from peritonitis. I am afraid history is repeating itself with 3 serious flare ups in the last 60 days and 4 rounds of antibiotics. Should I just have everything removed? The surgeon mentioned in our only encounter that when he can do the scope, he can see what he is dealing with and see if he can take a little piece? Thoughts? And I know this isn't for immediate medical advice. I will see my surgeon in a couple of weeks. Last thing, my original surgeries happened in Canada, I am now in the US, just in case you wonder why I don't go back to my surgeon as he knows what he is dealing with. <br />Appreciate your thoughts.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-19608368358709616492017-01-19T17:25:53.135-08:002017-01-19T17:25:53.135-08:00I'm sorry, Ms Beale, but my aim here is to pro...I'm sorry, Ms Beale, but my aim here is to provide general information; I really don't want to get into specific advice or opinions when I can't know anywhere near as much as his doctors. I understand how frustrating these things can be, and I sympathize. But I don't want to go further than I already have.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-39093879006963500732017-01-19T15:18:09.008-08:002017-01-19T15:18:09.008-08:00 Hi Dr Scwhab my husband has been discharged for a... Hi Dr Scwhab my husband has been discharged for a few days now and the combo flagyl and cipro seem to be taking their toll on him. Do you usually tell patients to stick it out? He is feeling flulike, foggy, nausea, diarrhea... of course we have a call into the doc but just curious on your thoughts. Also his right abd pain is returning which he has felt on and off since the before appendectom... describes it as same pain we initially went to ER for 5 weeks ago. Any thoughts? Thanks so much for your time!!!Anonymoushttps://www.blogger.com/profile/10788604881727973433noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-3001117140074207742017-01-15T09:41:08.540-08:002017-01-15T09:41:08.540-08:00The pathology report might show whether the append...The pathology report might show whether the appendix showed typical appendicitis, or if the "angriness" at the tip was from being adjacent to an area of inflammation. Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-4921605209428931382017-01-14T19:48:33.531-08:002017-01-14T19:48:33.531-08:00I can't thank you enough and I very much appre...I can't thank you enough and I very much appreciate the insite. They told him this morning they would send him home on augmentin tomorrow !? And he spoke up so they said flagyl and cipro.. finding myself frustrated... as I'm sure many people do in these situations. When you mention pathology, are you referring to the appendix report? I never thought to ask about those results... Anonymoushttps://www.blogger.com/profile/10788604881727973433noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-89321929440250220162017-01-14T18:55:44.313-08:002017-01-14T18:55:44.313-08:00Bladder and testicular pain can result from divert...Bladder and testicular pain can result from diverticulitis, as they can from prostatitis. Augmentin can be used to treat diverticulitis, but it's probably not the first choice. <br /><br />In most cases of prostatitis, there'd be some white cells in the urine and the prostate would be tender on exam. <br /><br />In most cases of appendicitis the entire worm is angry. The tip can get angry if it's touching an another area of inflammation, such as diverticulitis. Pathology reports might make the distinction. <br /><br />I say these things as general propositions, not with the intention of diagnosing your husband's situation, which I absolutely can't do from so far away. Happily, it sounds like he's on the mend. Your questions are good ones, and you should feel entitled to ask the docs taking care of him.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-14759638715929337772017-01-14T18:34:56.300-08:002017-01-14T18:34:56.300-08:00Dr Schwab, happy to have found your post! Thanks f...Dr Schwab, happy to have found your post! Thanks for all the insight.<br /><br />My husband, 33yo, had emergency appendectomy dec 11 and the surgeon said the appendix looked unhappy at the distal end and obviously removed it; he also fixed an umbilical hernia. <br /><br />20 days later we ended up in the ED again, this time with a cellulitis of the surgical site and perhaps a mild case of shingles. That part remains questionable. The CT we were told was normal, some inflammation at the surgical site but nothing unexpected. He was given a two week course of augmentin and valtrex for shingles. <br /><br />All seemed well for the past week until Wednesday he started complaining of what he felt was bladder pain. CT revealed sigmoid diverticulitis and he is now admitted and on IV Zosin. The lower midline abdominal pain is slightly and slowly improving but now he has testicular pain. No fever, CBC is within normal, urine clean. He does have a history of prostatitis about 5 years ago. The surgeon who did the appy did mention on his initial CT that his prostate is large for his age. <br /><br />I know I read in a previous comment you said the nerve tracts are common in this area. My question is, does this bladder pain and testicular pain line up with the diverticulitis diagnosis? Also, I would have thought him being on augmentin at home for the cellulitis would have prevented or simultaneously treated the diverticulitis, I am confused on this? Any insight would be appreciated. Anonymoushttps://www.blogger.com/profile/10788604881727973433noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-17226125044923891122016-12-28T13:17:38.492-08:002016-12-28T13:17:38.492-08:00Thank you Dr. Schwab, I appreciate your insight an...Thank you Dr. Schwab, I appreciate your insight and response. Dianenoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-66997658230860602682016-12-15T11:54:33.955-08:002016-12-15T11:54:33.955-08:00Sorry to hear of your brother, Diane. Re-reading m...Sorry to hear of your brother, Diane. Re-reading my post here I see I gave short shrift to the subject of perforation and peritonitis other to have mentioned it as a clear-cut indication for emergency surgery.<br /><br />The answer to your question is, yes, absolutely. I encountered many cases of perforated diverticulitis with sepsis and although I don't think any of them died, it's entirely possible, depending on timing of intervention, the patient's presenting condition, and response to the surgery, antibiotics, and other supportive measures. <br /><br />Whereas I obviously can't say whether perforated diverticulitis is the cause of your brother's sepsis and death, it fits.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-40860412731695831852016-12-15T09:37:51.756-08:002016-12-15T09:37:51.756-08:00My brother suffered for years with bouts of divert...My brother suffered for years with bouts of diverticulitis, he just passed away December 1, 2016, he was 58 years young. A few weeks before his passing he was having pain on his left side, debilitating enough that he had to lie down when the episodes came. I don’t know why he didn’t go see his doctor, but hindsight is 20/20. <br />The morning of his death he was running a fever, vomiting and collapsed at home. On the way to the hospital he blacked out. At the hospital he had a 105 degree fever and they could not stabilize him and his blood pressure was very low. The hospital said he died from Septic shock. <br />My question is, have you encountered a scenario like this in your practice? Could the pain he was having possibly come from an infected pocket in his colon from years of having diverticulitis, leaking into his abdomen, giving him the sharp pain eventually leading to the Septic shock? Ignoring it for not sure exactly how long, I’m wondering if it’s possible, infection and bowel was leaking into his abdomen and then would cease to be as painful as it was absorbed into his abdominal cavity. He also had chronic diarrhea. <br />His family decided not to have an autopsy. I would appreciate any insight you have in this matter. You have a great blog and have helped many people with your answers. Thank youDianenoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-56419920933436997452016-05-18T13:03:36.944-07:002016-05-18T13:03:36.944-07:00Thank you so much for your input! I am heading to...Thank you so much for your input! I am heading to the surgeon's office today.<br /><br />- StarlingAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-18254059497410158672016-05-15T20:01:50.645-07:002016-05-15T20:01:50.645-07:00Starling, whether they proceed or not will depend ...Starling, whether they proceed or not will depend on how severe the attack is. I think you should contact your surgeon's office right away about it. They may want to see you, maybe start you on antibiotics. Assuming things don't heat up too much, it's likely they could proceed and unlikely they'd need to do a colostomy. (Usual caveats, yadda yadda...) <br /><br />And after normal recovery there should be no impact on sexual activity of any sort. It would only be in the unlikely event (for a routine sigmoid resection) of the anastomosis (putting the ends back together) being done very low in the pelvis that it could, temporarily, affect receptive anal intercourse.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-82257782517259705962016-05-15T18:49:38.708-07:002016-05-15T18:49:38.708-07:00Hi Dr Sid,
I am hoping you are still able to rece...Hi Dr Sid,<br /><br />I am hoping you are still able to receive/respond to comments here. This is an outstandingly well-written and documented article - thank you for taking the time to share this with us.<br /><br />I have two questions I am hopeful you might be able to help with (given all caveats with distance)<br /><br />- I am scheduled to have a lap sigmoid resection in just over a week due to almost constant recurrent diverticulitis attacks, but I am again today in lower left quadrant pain and it seems like at the very start of a flare up ... can they operate if I am having a flare up? Would the surgery need to be postponed, and does it increase the complications or even risk of a stoma?<br /><br />- I am very embarassed to ask this, but I can't find any information anywhere ... after the sigmoid resection is complete and completely healed, is it still possible to have receptive anal intercourse? As its diverticulitis I assume the rectum remains intact? I am very worried about this.<br /><br />Many, many thanks,<br />StarlingAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-62216908225983673782016-01-30T08:45:42.398-08:002016-01-30T08:45:42.398-08:00I don't know if yours is a spam message or not...I don't know if yours is a spam message or not, Mark; but since you provided no link to whatever it is you're referring to, I'm posting your question. The bottom line is that the only recommendation for diet for diverticular disease is a high-fiber diet. The old recommendations to avoid various foods haven't held up; nor are there, far as I know, any specific recommended foods. I'd be skeptical of "diet" that recommends them, other than those that provide adequate fiber. The main thing is to avoid constipation, which generates higher pressures in the colon. So high fiber it is.<br />Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-72245615949563198292016-01-30T02:44:35.313-08:002016-01-30T02:44:35.313-08:00Hi Sid,
I am searching for a particular diet over...Hi Sid,<br /> I am searching for a particular diet over the internet for my diverticulitis disease and unable to find the rigth diet for it, can you please check this diverticulitispainfreefoods by Mike Hohlweg and let me know if it something that i should use, thanks, MarkAnonymoushttps://www.blogger.com/profile/13120153558924170072noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-20500933158110688482015-09-25T16:47:55.911-07:002015-09-25T16:47:55.911-07:00Thank you Sid for your response. Makes me feel a...Thank you Sid for your response. Makes me feel a lot better about this while thing.<br /><br />I wonder why they didn't detect any diverticulitis or any other cause on the CT? My thought is that by the time they did it the infection was gone - but I don't know why they did not see the pouches - perhaps they are hard to find on a CT.<br /><br />Regards,<br /><br />NKM<br /><br />NKMnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-28148725489795320332015-09-25T14:36:20.599-07:002015-09-25T14:36:20.599-07:00NKM, from what you describe it's almost surely...NKM, from what you describe it's almost surely due to diverticulitis; but, of course, based on the story alone I can't say with certainty that it's not due to cancer. <br /><br />I've touted the Canadian system many times, but two months seems a bit long. In the meantime it's probably best to get back in the fiber groove to make your stools as non-liquid as possible. The good news is that, barring another flare-up, by the time you see the surgeon things ought to be calmed down enough inside to go ahead with the surgery. <br /><br />In re-reading this post (it's been a while!) I note I mentioned fistulae in general, but didn't mention the not-rare complication of colovesical fistula specifically. Should have. But you seem to have discovered it on your own. The good news is that the surgery is only a little bit of a bigger deal than the routine sigmoid colectomy; usually, anyway. In my experience, once the colon and bladder are separated the colectomy part proceeds more or less as usual, and closing the hole in the bladder tends not to be a big deal.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-9407406101505102452015-09-25T13:54:44.655-07:002015-09-25T13:54:44.655-07:00Hi Sid,
I'm a 47 yr old male. About a year a...Hi Sid,<br /><br />I'm a 47 yr old male. About a year and a 1/2 ago I had terrible lower abdominal pain - It started with night sweats. Then bloody gas diarrhea with no pain. This bloody gas diarrhea suddenly stopped after about 4 weeks. Then a week later I began to have extremely extremely foul smelling BM's that were loose and I had constant lower pelvic pain and gas that would not seem to come out along with left side pain. I could not eat and lost 20+ pounds. This lasted for weeks until I saw a doctor who thought it was probably diverticulitis and gave me Flagyl. The Flagyl worked right away and I got better really quickly.<br /><br />I was never tested to see what it actually was but I added fiber to my diet, ate more veggies, got exercise and have been well over a year.<br /><br />Over time I forgot about the whole incident - dropped the fiber, and began to eat more like I used to, stopped going to the gym, drank beer again, gained weight etc. - back to the old me - feeling fine and living the good life.<br /><br />However, 6 weeks ago I started to get night sweats again - then 3 weeks ago I have had some more lower pelvic pain and left side pain - similar to a year and 1/2 ago along with the bad gas cramps - then a bad UTI started along with gas and poop in the urine and I am and remain a bit swollen in the left pelvis area just above the penis (I think this is where the fistula must be as I feel the gas move there).<br /><br />The doctor gave me CIPRO for 3 weeks which took away all the pain and the UTI. I feel fine now except for the gas and poop in urine. My doctor sent me for a CT scan and it confirmed a Colovesical fistula and now I've been referred to a surgeon (in 2 months as I'm in Canada and have to wait in line).<br /><br />I asked the doctor what caused the fistula - he said nothing on the CT scan gives any clue as to the cause.<br /><br />I am wonder what your opinion might be - do you think infection or Diverticulosis or a cancer caused this fistula? I assume if Cancer the antibiotics would not have been so effective however.<br /><br />Your opinion would be much appreciated,<br /><br />Thanks<br /><br />NKMnoreply@blogger.com