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Diverticular disease treatment in Ahmedabad · Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
Most people with diverticular disease never need an operation. Diverticula are small pouches that bulge out through the wall of the large bowel. When one becomes inflamed — diverticulitis — most episodes are uncomplicated and settle without surgery, and many well patients do not even need antibiotics. An operation is needed in an emergency when the bowel has burst, and is considered later for a few people: those with repeated attacks that affect daily life, a drained abscess, a fistula or narrowing, a weakened immune system, or a bowel in which cancer cannot be excluded. Two attacks alone are no longer a reason to operate.
Three words are used for one condition at different stages. Diverticulosis means the pouches are present but cause no symptoms — often found by chance on a scan or colonoscopy. Diverticular disease means they cause symptoms. Diverticulitis means a pouch has become inflamed, with pain, fever and tenderness, and it can be uncomplicated or complicated by an abscess, a perforation, a fistula, a narrowing or bleeding.
Dr. Jivraj Mehta Hospital. Trained in super-specialty surgical gastroenterology programmes, qualified twice over in the specialty, with 18 years of experience in planned and emergency bowel surgery. CT review, outpatient and in-hospital treatment of diverticulitis, coordination of image-guided drainage and of colonoscopy, emergency surgery for a burst bowel, planned keyhole colon resection, stoma care and stoma reversal sit within one practice.
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Laparoscopic Colon Surgeon · Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
Google rating 4.94 from 18 reviews at Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad.
A complicated episode can show itself in several ways: pain spreading across the abdomen with fever and a racing pulse when the bowel has burst; air or stool in the urine, or repeated urine infections, when the bowel has formed a channel (fistula) into the bladder; stool or wind from the vagina when the fistula opens there; or swelling and constipation when the bowel has narrowed. Bleeding from a diverticulum is different again — usually sudden, painless and heavy, and it stops by itself in most people. Each of these is treated on its own lines, described below.
In Western countries diverticulitis is mostly a disease of the sigmoid colon on the left side, causing pain in the left lower abdomen. In Asian patients, diverticulitis of the right side of the colon is far more common than Western guidelines assume. It tends to affect younger people, it usually settles without an operation, and it feels exactly like appendicitis.
Knowing this prevents two mistakes. The first is an unnecessary appendicectomy for right-sided pain that was diverticulitis. The second, more serious, is removing the right side of the colon for an inflamed lump that would have settled — an inflamed right-sided lump is never removed without a diagnosis, because tuberculosis of the bowel, which is common in this region, and a growth are also on the list. A CT scan usually tells right-sided diverticulitis apart from appendicitis and from these other causes.
The single most important step after an attack of diverticulitis is making sure it was not a cancer. A colon growth can look exactly like diverticulitis on a scan, so a colonoscopy is done six to eight weeks after recovery from a complicated episode, or whenever the scan features were unusual. It is never done during the acute attack, when it could perforate the inflamed bowel.
Features on CT that raise concern include a short, thickened segment with sharp edges, enlarged lymph nodes next to the bowel, and a narrowing that does not behave like inflammation. After a straightforward, CT-confirmed uncomplicated episode, a colonoscopy is not always needed if the scan was clear-cut and bowel screening is up to date — this is decided case by case. Other conditions considered alongside diverticulitis include appendicitis on the right side, inflammatory bowel disease, colitis from infection or reduced blood supply, gynaecological problems and intestinal tuberculosis. A narrowing that develops after recovery is not labelled benign until cancer has been excluded.
A contrast CT scan of the abdomen and pelvis is the test of choice for suspected diverticulitis. It confirms the diagnosis, grades how severe it is, and shows any abscess, perforation or free air. Clinical examination alone both over- and under-calls this disease.
| Test | What it decides |
|---|---|
| Blood count, CRP, kidney and liver tests | The degree of inflammation and fitness for treatment |
| Urine test, and urine culture if a fistula is suspected | Urine infection, and signs of a channel into the bladder |
| Pregnancy test in women of child-bearing age | Rules out pregnancy-related causes and guides imaging |
| Contrast CT of the abdomen and pelvis | The diagnosis and grade: uncomplicated, abscess, perforation or free air |
| Ultrasound | A reasonable first test in young patients or where CT is not available; a normal ultrasound does not rule diverticulitis out |
| Colonoscopy, six to eight weeks after recovery | Excludes a colon cancer after a complicated episode or an unusual scan — never during the attack |
| CT with contrast through the back passage, and cystoscopy | When a fistula into the bladder is suspected |
The CT grade decides the treatment. Uncomplicated diverticulitis shows a thickened wall and inflamed fat with no abscess or free air. Complicated diverticulitis ranges from a small abscess next to the bowel, to a larger abscess in the pelvis, to pus spread through the abdomen, to stool in the abdomen — the last two are the Hinchey grades that need an operation.
| Finding on CT | Usual treatment |
|---|---|
| Uncomplicated: thickened wall, inflamed fat, no abscess or free air | Treatment at home or in hospital; antibiotics often not needed in a well patient |
| Inflamed lump or a small abscess next to the bowel | Antibiotics, with drainage if needed |
| Larger abscess in the pelvis or further away | Antibiotics and drainage through a needle under scan guidance |
| Pus spread through the abdomen (purulent peritonitis) | Emergency operation |
| Stool in the abdomen (faecal peritonitis) | Emergency operation, usually with a stoma |
Most attacks are uncomplicated and settle with treatment that does not involve surgery. Most second attacks after an uncomplicated first one are also uncomplicated, and the chance of eventually needing an emergency operation falls, rather than rises, with each uncomplicated attack. That is why the old rule of operating after a set number of attacks has been dropped.
Treatment ranges from advice and observation, through antibiotics by mouth or drip, to drainage of an abscess, emergency surgery, and a planned operation after recovery for selected patients. The lowest safe level is used first, and the patient is reassessed at two to three days if they are not improving.
| Treatment | Suited to |
|---|---|
| Observation without antibiotics | Uncomplicated diverticulitis on CT in a well patient with a normal immune system, eating and drinking, who can be reassessed |
| Antibiotics by mouth, usually for five to seven days | Uncomplicated disease with fever, other illnesses, frailty, pregnancy or a weakened immune system |
| Hospital admission, antibiotics by drip, bowel rest as tolerated | Complicated disease, or failure to improve |
| Drainage through a needle | An abscess larger than about four to five centimetres |
| Emergency operation | A burst bowel with pus or stool in the abdomen, obstruction, or failure of the above |
| Planned operation after recovery | Selected patients only — the reasons are listed further down |
When antibiotics are given to a well patient, tablets work as well as a drip. If a patient on antibiotics has not improved within two to three days, the answer is a repeat scan rather than stronger antibiotics, because an undrained abscess — or the wrong diagnosis, including cancer — may be the reason.
For a well person with CT-confirmed uncomplicated diverticulitis, antibiotics can safely be left out, as randomised trials and the international emergency guidelines support. Treatment at home is appropriate if the patient can eat and drink, has support at home, and can come back quickly if things worsen.
That last condition matters in practice. Leaving out antibiotics, and treating at home, both depend on the patient being able to return. For someone who lives far away or cannot easily come back, the safer choice is to admit or to give antibiotics, and the reason is explained and written down. Antibiotics are given where there is sepsis, a weakened immune system, significant other illness, frailty, pregnancy or inability to eat and drink. Most small abscesses settle on antibiotics alone. And for the large majority of people who have had one or two uncomplicated attacks, no operation is needed at all — the focus moves to prevention.
When diverticulitis has burst and spread pus or stool through the abdomen, an emergency operation removes the diseased segment of bowel. The patient is resuscitated and given antibiotics first; the aim of the operation is to control the source of infection, and a stoma made for safety is not a failure.
| Situation | Operation |
|---|---|
| Pus through the abdomen, stable patient in reasonable health | Removal of the sigmoid, with the bowel joined and a temporary protective ileostomy; this route has a better chance of the stoma being closed later |
| Pus through the abdomen, unstable or high-risk patient | Hartmann’s operation — removal of the sigmoid with an end colostomy |
| Stool through the abdomen | Hartmann’s operation |
| Obstruction | Removal of the narrowed segment; join or stoma depending on the patient’s condition and contamination |
| Bleeding that cannot be controlled otherwise | Removal of the bleeding segment if located; a larger colon removal only if it cannot be found |
A join is not made in a patient who is unstable, heavily contaminated, malnourished or on drugs that weaken the immune system. Keyhole washing-out of the abdomen without removing bowel, once promoted for pus in the abdomen, led to more repeat procedures in trials and is no longer a standard option. Wherever time allows, the stoma site is marked before the operation, and the reason a join was or was not made is recorded.
The long-standing teaching that the sigmoid should be removed after two attacks has been abandoned. A planned operation is now an individual decision, revisited after each attack, based on how much the disease affects life and on whether it has caused complications — not on a count of episodes.
★★★★★
“Excellent service, very polite, very well explained the treatment plan and follow up after surgery. I am truly grateful to him for the treatment. — Amar Singh, Google review”
★★★★★
“I must say Dr harsh shah is very calm and humble in nature towards there patient.My wife had been operated by him.Thank you so much sir.Dr harsh shah is expert Gastro surgeon. — Ashokbhai Brahmbhatt, Google review”
★★★★★
“Dr. Harsh performed my wife’s gallbladder surgery and has been a thorough professional. He truly assuaged our concerns and treated us with great care. I have never met a surgeon who is consistently upbeat, and that makes a real difference to families whose loved ones are undergoing a surgical procedure. — Gaurav Roy, Google review”
The reviews below are from Dr Harsh Shah’s two Google listings, quoted exactly as written. None names diverticular disease; they describe his surgical care more generally.
When a planned operation is chosen, it is done by keyhole surgery wherever feasible. The diseased sigmoid is removed down to the soft, healthy upper rectum, and the bowel is joined. Leaving a piece of the lower sigmoid behind is the commonest reason diverticulitis returns after an operation.
The upper end of the removal is set at healthy, uninflamed bowel; it is not necessary to remove every pouch in the colon. Because this is not a cancer operation, the main artery to the left colon can usually be preserved, which lowers the risk of injury to the nerves that control the bladder and sexual function. In a heavily inflamed pelvis, or at a repeat operation, stents may be placed in the ureters (the tubes from the kidneys) beforehand so that they are easy to identify. Before surgery, anaemia and diabetes are corrected, smoking and alcohol are stopped at least four weeks ahead, the bowel is prepared with a preparation taken together with oral antibiotics, and a stoma is discussed with every patient, even when it is unlikely.
Bleeding from a diverticulum is usually painless, sudden and heavy, and in most people it stops by itself. Treatment starts with resuscitation and correction of any clotting problem. If bleeding continues, a CT angiogram finds the source and a radiologist blocks the bleeding vessel through a fine tube (embolisation); a colonoscopy after bowel preparation can also find and treat it.
An operation for bleeding is a last resort, kept for bleeding that cannot be controlled in these ways. If the bleeding point is known, only that segment is removed; a larger removal of the colon is done only when the source cannot be found. Painkillers of the NSAID group should be avoided where possible by anyone with diverticular disease, because they are linked to both bleeding and perforation.
A fistula is a channel that forms between the inflamed colon and a neighbouring organ, most often the bladder — causing air or stool in the urine and repeated urine infections — or the vagina. A narrowing (stricture) can follow repeated inflammation and cause constipation, swelling or blockage. Both are usually treated with a planned operation.
A suspected fistula into the bladder is confirmed with a CT scan with contrast given through the back passage, and a cystoscopy; a fistula into the vagina with CT and an examination under anaesthesia. A narrowing is investigated with CT and colonoscopy, and it is never accepted as benign until cancer has been excluded, because a cancer can narrow the bowel in exactly the same way. The planned operation removes the diseased segment and repairs the other organ, with the bladder protected where the fistula is separated.
After a planned keyhole sigmoid colectomy, patients sit out of bed and drink on the day of surgery, eat and walk on the first day, and most go home on the fourth or fifth day. After an emergency operation, recovery is slower, sometimes with intensive care, and learning to look after the stoma takes up much of the hospital stay.
| Day | What happens |
|---|---|
| Day of surgery | Sitting out of bed within hours, clear fluids, pain relief with few opioids, drip stopped once drinking |
| Day one | Diet as tolerated, walking four times, urinary catheter removed |
| Day two | Full diet, more walking, pain relief by mouth, wind usually passing |
| Day three | Bowels opening, readiness for home checked |
| Day four or five | Home, with written follow-up and warning signs |
No tube through the nose and no drain are used routinely after a planned operation. A patient with a stoma goes home only when the patient or a family member can manage it without help, and a colonoscopy is arranged before discharge if it has not already been done. Fever, a fast pulse, new or worsening pain, or a patient who stops improving are reasons to stop and call the surgeon at once — they can be the first signs of a leak from the join.
Emergency operations for burst diverticulitis carry much higher risks than planned ones, and they are consented for separately. The two things that most need to be understood are the stoma — how likely it is in each situation, and that some “temporary” stomas are never closed — and that a planned operation reduces, but does not abolish, future attacks. The figures that apply to each patient are given at the consent discussion.
General: bleeding needing transfusion, wound infection, clots in the leg or lung, heart or breathing problems, anaesthetic complications, and conversion from keyhole to open surgery, more likely with dense inflammation. Specific to this operation: a leak from the join, a temporary or permanent stoma, an abscess in the abdomen, a slow return of bowel function, injury to the ureter, injury to the bladder when a fistula is separated, narrowing of the join, a hernia at the wound or the stoma later, adhesions causing blockage, and diverticulitis returning even after removal, particularly if lower sigmoid is left behind. There is a risk to life, low after a planned operation and much higher in an emergency with pus or stool in the abdomen. Also: the removed bowel is examined under the microscope, and occasionally an unsuspected cancer is found; closing a stoma is a further operation with its own risks.
The long-term measures that help are a high-fibre diet, enough water, regular physical activity, weight control and stopping smoking. The old advice to avoid nuts, seeds and popcorn has no evidence behind it — they are not forbidden.
Many patients arrive having given up foods they enjoy because of that advice; they can eat them. NSAID painkillers should be avoided where possible. Mesalazine, rifaximin and probiotics have not been shown to prevent further attacks, so they are not prescribed for that purpose.
After a complicated attack, or when the CT looked unusual, a colonoscopy six to eight weeks later to exclude cancer is the single most important follow-up step. After an operation, the wound and any stoma are reviewed and the specimen report is discussed at about six weeks, and bowel function is assessed at three months.
If a stoma was made, its reversal is planned at follow-up, with a contrast X-ray of the join or the rectal stump beforehand. Fibre, fluids, activity, weight and avoiding NSAIDs are reviewed at each visit. For anyone who has not had an operation, the question of a planned operation is revisited after each new attack — on its merits, not on the count.
The cost depends on whether treatment is at home or in hospital, whether drainage is needed, whether the operation is planned or an emergency, whether a stoma is made and later closed, and the length of stay. A written estimate is given before a planned admission and as early as possible in an emergency.
Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad, works with the major insurers and cashless schemes, and the office handles pre-authorisation directly, including emergency admissions. Bring: CT images on a disc or drive with reports, colonoscopy reports, blood and urine reports, discharge papers from each attack, a list of medicines, the insurance card and identification.
Not automatically. The decision now depends on how much the attacks affect your life, whether any was complicated, your immune system, and whether cancer has been excluded — not on the number of attacks.
No. A well person with uncomplicated diverticulitis confirmed on CT, who can eat, drink and come back if worse, can often be treated without antibiotics.
No. That advice has no evidence behind it. A high-fibre diet, enough fluids, activity and not smoking are what help.
Because a colon cancer can look exactly like diverticulitis on a scan. It is done six to eight weeks after a complicated or unusual attack, never during it.
After a planned keyhole operation it can usually be avoided. In an emergency for a burst bowel a stoma is likely, and some temporary stomas are never closed; your own likelihood is discussed before surgery.
It is less likely but still possible, especially if part of the lower sigmoid is left behind — which is why the removal is taken down to the healthy upper rectum.
Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
Dr. Jivraj Mehta Hospital, Dr Jivraj Mehta Marg, Vasna, Ahmedabad 380007.
Google: Dr Harsh Shah · 4.94 from 18 reviews
Directions to Dr. Jivraj Mehta Hospital, Vasna · WhatsApp +91-63555-64601
Patients come to Ahmedabad from across Gujarat — Gandhinagar, Mehsana, Banaskantha, Nadiad, Anand, Bhavnagar, Rajkot, Jamnagar and Kutch — and from southern Rajasthan and western Madhya Pradesh.
Treated for diverticulitis, or told an operation may be needed? The CT scan images and report, any colonoscopy report, blood reports and the discharge papers from each attack can be sent ahead of the appointment, so the consultation starts with them already read; treatment is decided at the consultation, after examination. Severe abdominal pain with fever, or a hard, tender abdomen, needs the nearest emergency department now. Call +91-63555-64601 · Bring the reports to the visit
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