Expert care for diverticular disease

For Elaine Wigglesworth, the ‘home from home’ treatment she received from doctors at Mediclinic Cape Town made all the difference in her recovery from diverticular disease.

We asked her doctors about treatment and management of the condition.   

When Elaine first experienced symptoms of diverticular disease on a flight from Dubai to Cape Town she knew little about it and thought she had ‘a touch of gastro’. But when she later experienced pains on the left side of her lower abdomen she sought medical assistance and was referred to Dr Martin Crots, who confirmed his diagnosis of diverticulitis through an MRI.

The collaborative care provided by Dr Crots and Dr Pieter Coetzee, both general surgeons and gastroenterologists who practice at Mediclinic Cape Town, and specialist physician Dr Neville Govender, also of Mediclinic Cape Town, was life-changing for Elaine.

‘We worked together as a team,’ she says. ‘I really appreciated this because they listened to me and met my needs as a patient. During my many fearful and anxious moments in ICU, their bedside manner brought me calmness, compassion, empathy and hope. They truly shared a passion for improving the quality of my life and the lives of my family, for which I’ll be eternally grateful.’

What is diverticular disease?
Common in older people, diverticular disease affects as many as 60% of people around the age of 60. Diverticular disease occurs when small bulges or pockets (diverticula) develop in the lining of the intestine. Diverticulitis happens when these pockets become inflamed or infected.

‘Complications in the form of bleeding and infection occur in 5-8% of people with diverticular disease,’ Drs Crots and Coetzee explain. ‘Bleeding can be massive, requiring transfusion and hospitalisation. Infection is graded from 1 to 4 according to CT scans, and treatment varies from oral antibiotics to surgery for severe infection.’

In Elaine’s case, strong antibiotics were administered via an IV drip to control an infection of the sigmoid colon (the part of the large intestine closest to the rectum), and she underwent surgery to remove 20cm of the diseased sigmoid colon.

Symptoms
Diverticular disease is generally asymptomatic, meaning many are unaware of the condition until complications occur. ‘Patients sometimes have mild pain in the lower left part of the abdomen,’ say Drs Crots and Coetzee. ‘In terms of complications, the symptoms can be blood in stools or severe pain in the lower abdomen, fever and even bladder symptoms.’

Treatment
‘Treatment is directed towards the symptoms,’ the doctors explain. ‘Bleeding is treated with systemic support, fluids and/or blood transfusions. Infections are treated according to severity – mild infections are treated with oral antibiotics but more serious infections might require intravenous antibiotics. Sepsis is treated with surgery, which includes removal of the affected colon and washing out of the intra-abdominal infection.’

In Elaine’s case, sepsis set in after surgery as her colon ruptured because of the infection. A team of doctors with different specialties was therefore needed to treat complications.

‘The multidisciplinary team helps to manage the different systems better,’ Drs Crots and Coetzee explain. ‘Each system is managed by an expert in that field. Good communication between specialists is vital, and one person must always be the final responsible treating doctor.’

Open communication
Elaine’s experience highlights the importance of good communication with patients.

‘Open communication is important, because while we all have good intentions, complications do occur. The management of these complications and how the patient responds to them depends on your rapport with the patient and family,’ say Drs Crots and Coetzee.

‘Due to the professional care I received, I lived to witness the birth of my first grandchild – although there were many times during the multiple complications that I thought I would never see this day!’ says Elaine, who recovered and remains under the care of Dr Crots for monitoring of her condition and progress.