What is the treatment for diverticulitis and do doctors operate?

[jjean]

Does anyone know about diverticulitis? I had pain on my left side and trouble pooping and went to the ER. They took a CT scan and said I had diverticulitis with inflammation.  I was given antibiotics, and later told to get IV antibiotics.  But when I was in the hospital the doctor said I was schedule for a surgery consultation, and no one told me they were considering surgery. I got scared.  The surgeon said she wanted to take out part of my sigmoid colon and give me a colostomy bag. Then they did a sigmoidoscopy on me (this is a partial colonoscopy) and an MRI and said the inflammation was too bad, and had to wait until it got better. I was sent home with strong antibiotics for a month.  When I was home I saw my MRI results online and it said I had an enlarged presacral lymph node with an intermediate T-2 signal "concerning for lymphangitic metastatic spread," and a 7 mm area of wall thickening in my sigmoid colon and a "maglignant neoplasm cannot be excluded."  But my doctors never told me this.  So, I called the doctor, and her nurse said said diverticulitis causes lymph nodes to get enlarged.  Is this true? How do I know if this is cancer?  I feel a hard lump on my left side the size of a lentil when I press on my colon. What causes an abnormal T-2 signal?  What causes wall thickening in the sigmoid colon? I had a follow-up with a PCP and he did not think I needed surgery, and would not explain the abnormal MRI tests. What should I do?

[CHIN_C]

Patients with uncomplicated diverticulitis without perforation can be treated with oral antibiotics. On the other hand, patients with complicated diverticulitis with perforation are usually sent to the hospital for intravenous antibiotics, drainage of abscess, etc. Surgery may be considered if there are complications, such as abscess, fistula, or obstruction. Surgery may also be considered if a patient has multiple episodes of uncomplicated diverticulitis.

Bowel wall thickening can be caused by infection, inflammation, or cancer. Because bowel thickening/fat stranding in diverticulitis can mask other pathology, lower endoscopy is typically performed after resolution of the acute process to rule out underlying cancer. In your case, it sounds like sigmoidoscopy was performed but was indeterminate/inconclusive.

Lymph nodes can be reactive or metastatic in etiology. For example, if you had sigmoid diverticulitis, you may have tiny lymph nodes around the sigmoid colon. However, it is uncommon to have presacral/perirectal lymph nodes, as lymph nodes are not typically seen in this region, even small ones. This is why the MRI report suggested possible metastasis.

Taking everything into account, having persistent bowel wall thickening, having indeterminate/inconclusive endoscopy, and having a lymph node in a place where you should not have a lymph node, your situation is suspicious for cancer. You should have a frank discussion with your doctor and weigh pros, cons, and alternatives of treatment options.

[jjean]

Thank you so much.  I did ask my doctor (the surgeon) about the lymph node, and she said it was swollen because of the inflammation.  But I am not sure she is telling me correctly.  What other treatment options are available, and can an ultrasound diagnose me better?  

[CHIN_C]

Ultrasound is less sensitive/specific; it would not be able to diagnose you better. Consider repeat MRI,  or alternatively CT or PET/CT. Some time has elapsed since your initial MRI. If the bowel wall thickening and lymphadenopathy improves/resolves, then this more reassuring, favoring infectious and/or inflammatory etiology. If the bowel wall thickening and lymphadenopathy persists/worsens, then this more concerning for cancer/metastasis and surgery may be considered.

[CHIN_C]

By doctor, I meant you should see a GI surgeon, not PCP.

[specialmom]

Hi.  Our friend was diagnosed with this and was very miserable.  He is scheduled for surgery in February for it.  My husband had a mild case and he got antibiotics.  He also was very miserable but he over reacts when sick so it's hard to say.  lol  Just being honest there. But you are probably quite uncomfortable.

That's not really helpful but just other's experience.  I think Chin_C has advised you very well to follow up as soon as possible.  I'm sure you are very scared. That this could be a malignant situation is frightening.  But you need to know in order to begin treatment.

They are proposing surgery?

[jjean]

I hope your friend is doing better and does not need the surgery. Please have him get a second opinion, and maybe an ultrasound to see how serious his  diverticulitis is.  Mine was a ruptured diverticulitis.  Te doctor never tole me this.  I saw it on my test result. The surgeon  wanted to remove part of my colon and give me a colostomy bag.  But I refused.  I was scared.  The cancer in my test results were never told to me.  The doctor never told me.  I saw the results online in the patient portal.  I am suspicious of the doctors and want a different one.

[CHIN_C]

You cannot see diverticulitis with ultrasound. Only CT or MRI will show it.