Complicated diverticulitis with abscess, no elective colectomy??

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Hello,

I am 47 years old and I just had an accute episode of diverticulitis with an abscess (2cm). I went to the ER with fever and abdominal pain. I spent 5 nights in the hospital on IV antibiotics and was then sent home with a picc line to receive daily IV infusions at home for 9 days, now I am on oral antibiotics. My recent CT showed the abscess is gone and diverticulitis has improved. My surgeon is highly recommended and knowledgeable and I do trust him. However, it does make me nervous not having an elective colectomy since the guidelines state that 1 complicationed case of diverticulitis warrants surgery. He said that most data is based on outdated studies and the current trend is to wait on having elective surgery for someone like me that is responding. Has anyone else with an abscess have similar recommendations from their surgeon? I kinda feel like a ticking time-bomb. 

 

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  • Posted

    I was in a similar situation. I had an acute episode 5 years ago and the doctors said I had a small abscess. They did nothing for it except give me antibiotics. I was out of hospital two days later and after a week I felt back to normal. The surgeon who later did the colonoscopy suggested I have surgery, but he was terrible. Said colonoscopy results looked good but was very vague and wrote almost nothing in his report. I decided to not get surgery and took a wait and see attitude. I switched doctors. They took a look at the cat scan I had done during the acute attack of the year before and he said there was probably no abscess. I think getting to know your body and trying to manage things without surgery is worth trying.
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  • Posted

    We don't do surgery in the UK unless it's life threatening.

    Try changing your diet and drink plenty of water.

    Good luck.

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  • Posted

    Hi Jean

    I understand your concern, but what you have been told is standard treatment for people living in the UK.  They only do surgery in emergencies or for people with very severe disease that has not responded to treatment and is severely compromising their quality of life.  There is no such thing as elective surgery on the NHS here.

    If the abscess has drained and you are healing up, as long as you follow a sensible suitable diet, and make sure your bowels empty regularly without straining by eating soluble fibre and taking a stool softener, you can lead a totally normal life. 

    There are always risks with surgery, and once your colon is gone, it's gone.  You will read posts here from people who have had the surgery because their life had become impossible.  But you will also read of people who develop other complications, like hernias and adhesions, swapping one problem for another.

    I think in the USA the tendency is to jump before you are shot, and of course it lines the surgeon's pockets.  Where's the profit in sending someone home with Metamucil and a diet sheet?  Your surgeon sounds a responsible modern person.  He has not ruled out surgery in your case, just a conservative wait and see approach. 

    You will take time to recover, as the medication is very strong, but you will find that as you improve your confidence will return.  I have had this disease since 2001 and manage it by diet and stool softener.  I went 6 years before my first flare, which was treated with medication only.  Like me, a lot of people have said they had the flare because they got complacent and ate food they knew from experience upset them.

    But everyone is different with this disease.  I hope you recover with no need for surgery.  Best wishes.

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    • Posted

      Thanks so much for the advice. I hate having this feeling of impending doom, but I really need to change my thought process on this. The whole ER event was traumatic for me. I have never had a symptom before and to have this now came as quite a shock. It’s good to hear success stories with conservative management. So much of what I’ve been reading online is so scary. 
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    • Posted

      Hi Jean

      Yes, it takes time to realise that people mostly post when they have problems, and don't if all goes well. (A biased sample - I used to be a statistician before I retired lol!!!).  It does take time to get over an attack, and patience is needed.  The forum gets all sorts of queries about timings and symptoms for the first month or so, then nothing.  A few will report back a few months later saying they are improving and feel much better.

      I've found the younger the person, the less patience they have, often because they are being pressurised to return to work whilst still feeling ill, or have family pressures.  Employers mostly have no understanding or sympathy with this disease.  So keep records of everything if you think you might fall into this category.

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    • Posted

      Thank you for your response, it definitely helps ease my mind. You’re so right, lots of obligations and pressure from all directions! It’s hard to explain to others the amount of time healing takes. So many people say oh, I have diverticulosis too... Well, the ITIS is much worse than they seem to understand. Honestly, I knew nothing myself about this until now. 
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  • Posted

    I am in the USA and they could not wait to take out my sigmoid colon. I did not want that. I asked the surgeon how many of "these" has he done. 8 he replied. I ran, not walked out of there, went to Stanford University where there are doctors who do 8 of "these" a week.

    If you are going to have it done, please have it done in a hospital that specializes in it.

    If you really want surgery, start complaining your ass off. Diverticultis, when it is severe can kill you. 

    If the diverticula rupture you will end up with abdominal sepsis.

    It is up to you, if you can live with pain, do it. The surgery, even at Stanford University is incredibly painful. Not during the surgery (of course they knock you out) but for at least a week or 2 afterwards.  

    IF you really want the surgery, research the places that do it and go see someone THERE. 

    Worst pain I ever been in after having my sigmoid colon removed. I would advise you to live with it if you can, and get a better surgeon if you can't.

    Best,

    Cecil

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