Dear Doctors: I am considering having sigmoid surgery. Five years ago, I had pancreatic cancer. I have also had multiple episodes of diverticulitis. Is there any information about how common post-op diarrhea is after this surgery? Is it constant, or does it eventually stop?
Dear Reader: Your questions cover several health issues, so let's begin with diverticulitis. This is an inflammatory condition that affects the gut. While diverticulitis can occur in the small intestine, most cases develop in the large intestine, or colon.
The condition begins with the formation of small bulges or saclike pouches along the inside walls. Known as diverticula, they are common to form as people reach middle and older age. The presence of these pouches is called diverticulosis. In most cases, diverticula are "silent" and do not cause any problems. But in some people, they become inflamed. When this occurs, it is a condition known as diverticulitis.
Diverticulitis can cause abdominal discomfort and pain that can become severe. If an infection occurs, symptoms can include fever, chills, nausea, vomiting, diarrhea, constipation and bloating. In severe cases, partial or complete bowel blockage can lead to a rupture of the tissues of the colon.
The first line of treatment is supportive care to manage symptoms. This often includes a diet of clear liquids for several days to help ease inflammation. In some cases, antibiotics may be used to address infection.
When diverticulitis is severe, or when repeated episodes put the person's health and quality of life at risk, the sigmoid surgery you are asking about becomes an option. Also known as sigmoid colectomy or sigmoidectomy, it involves the removal of part or all of the sigmoid colon. This is the S-shaped portion of the large intestine, located in the lower left of the abdomen, that connects the final section of the colon to the rectum. Because this part of the colon undergoes contractions to move food waste into the rectum, it is a site of high pressure. As a result, it is susceptible to the development of diverticula.
One of the jobs of the colon is to extract water from the semi-liquid waste it receives from the small intestine. Shortening the sigmoid colon gives the large intestine less time and less real estate in which to remove enough water to create solid stool. As a result, a common post-operative side effect of sigmoid surgery is loose stools or, in some cases, diarrhea.
Severity and duration vary depending on each specific case. For many people, the body adjusts and the aftereffects resolve over time. Dietary changes such as smaller and more frequent meals and limiting high-fiber food can aid in recovery. In some cases, anti-diarrhea medications may be prescribed.
You also mentioned you had pancreatic cancer five years ago. This is likely to factor into your doctors' guidance. Existing scar tissue from previous surgeries and your current health will all be considered. Sigmoidectomy is a major surgery with a significant recovery period. Great care is needed when choosing it as an elective procedure.
(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
