June 30, 2023

Complex Diverticulitis Case Highlights Importance of Second Opinions

Input from specialists and other healthcare providers is important when discussing quality-of-life improvement options

diverticulitis

Diverticulitis can be classified as acute or chronic as well as complicated or uncomplicated. While most cases are uncomplicated, this condition can become complex when problems secondary to inflammation arise. For instance, severe acute inflammation can cause diverticula to rupture. Scarring can occur in cases of chronic inflammation.

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More than half of the population can suffer from this condition, according to Emre Gorgun, MD, Vice Chair, Colorectal Surgery, Cleveland Clinic, who notes that diverticulitis can have a significant impact on a patient’s quality of life. It can lead to several other complications including gastrointestinal bleeding, intestinal obstruction, fistulas, abscess and gastrointestinal perforation.

When the condition is symptomatic, surgery might be the definitive treatment for diverticulitis, says Dr. Gorgun, and in cases of perforation and complicated presentations with abscess, perforation, etc., emergency surgery is necessary.

“Diverticulitis can expand, extend and involve adjacent organs,” he explains while emphasizing that this condition is a significant healthcare problem. “When the condition is advanced, surgery is often more complicated and, in those circumstances, seeking care from specialist centers is warranted.”

Below, Dr. Gorgun shares his experience with a complicated diverticulitis case that underscores the importance of collaborative and specialized care.

Patient case details

In this case, a patient was left with a partially treated disease and a colostomy prior to receiving care and decided to come to Cleveland Clinic for a second opinion, explains Dr. Gorgun. “This patient,” he notes, “had surgery for diverticulitis at another hospital, which failed. He underwent a laparotomy and was ultimately given an ostomy bag.

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“Allegedly, the patient was told that he would have to live with the bag for the rest of his life, and he cannot have his stoma reversed and complex diverticulitis segment removed,” says Dr. Gorgun.

Based on his own review of the case, Dr. Gorgun did not agree with the initial assessment and treatment approach. “Given what he was told by his previous physician, the patient was hesitant to undergo surgery,” recalls Dr. Gorgun. “While acknowledging the complicated nature of the surgery, I explained that, in my opinion, the benefits to his health and quality of life outweighed any potential risks.”

Subsequently, Dr. Gorgun performed pelvic surgery. “His diverticulitis was inflamed and invading the bladder to a degree. We had to clear everything, clean the infection and create a reconstruction,” he explains.

“This was an extreme case involving not only the sigmoid colon, but the disease was so complex that I also had to remove his rectum, which was affected by the infection, to be able to reconstruct his anatomy and reverse the ostomy.”

The patient did well post-operatively and his quality of life has significantly improved, Dr. Gorgun reports. “The patient remained in the hospital for a few days and post-operative care was very streamlined,” he says. “There were no adverse effects associated with the surgery.”

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If the patient had not undergone surgery, he would have faced negative outcomes and worse quality of life in the long term, Dr. Gorgun states. “His quality of life would be extremely diminished. He would be hooked up to a bag for the rest of his life and he wouldn’t be able to use the natural course of bowel continuity.”

Lessons learned

This diverticulitis case is an example of the value of getting input from specialists and other healthcare providers to ensure the best possible outcomes, Dr. Gorgun notes. “If this patient hadn’t sought a second opinion, he would have lived with a bag for the rest of his life and likely had problems in the future from the unresected disease segment of diverticulitis.”

In addition to always seeking a second opinion, Dr. Gorgun emphasizes the importance of looking for quality-of-life improvement options when considering treatment approaches.

“This patient’s case exemplifies how specialized centers can provide excellent care and find options that may go beyond standard recommendations,” Dr. Gorgun concludes while urging patients and providers to seek referrals and second opinions, especially in more complex cases.

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