Diverticular Abscess and surgery
Diverticular abscess is the common encountered acute abdominal problem for patients over 50 years of age. They may be required to undergo single or multiple operations. Percutaneous drainage of the abscess may allow a single medical operation in a select number of patients. Emergency surgery usually involves two operations. The first surgery will clear the infected abdominal cavity and remove part of the colon. Because of infection and sometimes obstruction, it is not safe to rejoin the colon during the first operation. Instead, the surgeon creates a temporary hole, or stoma, in the abdomen.
The end of the colon connected to the hole, a procedure called a colostomy, this is to allow normal eating and bowel secretion. The stool moves into a bag attached to the opening in the abdomen. In the second operation, the surgeon rejoins the ends of the colon.
With this procedure it makes colostomy unnecessary. This approach is probably underutilized and should become the procedure of choice in selected patients who do not have medical problems such as what doctors call immune-suppression. We report two patients, including one with a fecal fistula, in whom percutaneous drainage converted a situation in which two operations, one with a colostomy, would have been required, to a single operation without a colostomy. This approach saves about more than a thousand dollars per patient. The avoidance of colostomy and the cost savings make this approach attractive in selected patients with diverticular abscesses.
Medical history reference such as twenty-four patients suffering from acute sigmoid diverticulitis and associated pelvic fluid collections were seen on computed tomographic scans underwent percutaneous catheter drainage as an adjunct to surgical therapy. Fourteen of the twenty-four undergo a single-stage surgical procedure within 10 days of drainage. Five patients needed to undergo on a two-stage surgical method because of localized inflammation changes precluding a primary resection despite the absence of a residual abscess during surgery. Two of the three remaining patients had no surgery but they had recrudescences of their symptoms that required surgical drainage within 8-month period.
When taking a medical history, the doctor may take note of your about bowel habits, pain, symptoms, daily diet and present medications. The physical exam usually involves a digital rectal exam. To perform this test, the doctor inserts a lubricated gloved with a finger penetrating the rectum to detect tenderness, blockage, or probably blood. The doctor may check stool for indication of bleeding and test blood for indication of infection. The doctor may also order other tests and procedures required to detect the illness.
On the emergency surgery side, this usually involves two operations. The first surgery should clear up the infected abdominal cavity and remove a small part of the colon. Due to infection and at times obstruction, it is not safe to rejoin the colon during the first operation. Instead, the surgeon creates a temporary small hole, or stoma in the patients abdomen. The end of the colon will be directly connecting to the hole. This procedure is called colostomy that allows the patient to have a normal eating and bowel movements. The stool goes into a bag attached to the opening in the abdomen. In the second operation, the surgeon rejoins the ends of the colon.