Pope Francis resumed his weekly appearances from a window in the Vatican to bless believers 2 weeks after his operation on July 4th. The Pope had almost half of his colon removed due to severe constriction of the colon.
“His Holiness Pope Francis was brought to the A. Gemelli Polyclinic in Rome, where he [underwent] a planned surgery for symptomatic diverticular stenosis of the colon, “said Matteo Bruni, director of the Holy See’s press office.
This operation marked Pope Francis’ first significant health problem since he became Pope 8 years ago. He rarely misses scheduled events unless he has recurring episodes of sciatica or the occasional cold. The only other significant operation the Pope had was when he had part of a lung removed from him at the age of 21 due to pneumonia.
Diverticulosis is a condition that occurs when small bags or sacs form and push outward through weak spots in the colon wall. They are most common in the sigma.
When diverticulosis is causing symptoms or problems, it’s called diverticulosis. Symptoms include changes in bowel movements or pain in the abdomen. Diverticulosis can also cause diverticular bleeding and diverticulitis.
The prevalence of diverticulosis is highest in the western world and in countries with a more western lifestyle. It’s quite common, especially in old age. Research has found that about 35% of adults in the United States ages 50 and younger and about 58% of those over 60 have diverticulosis. Most people with diverticulosis never develop symptoms or problems.
Experts used to think that 10 to 25% of people with diverticulosis would develop diverticulitis. However, recent research has shown that the percentage who develop diverticulitis can be much lower – less than 5%.
In the United States, about 200,000 people are hospitalized for diverticulitis each year, and about 70,000 people are hospitalized for diverticular bleeding each year.
Acute diverticulitis (e.g., inflammation, infection, or perforation) is typically suspected when a patient presents with pelvic pain (especially on the left side). Patients may also present with tenderness in the abdomen and an increased number of white blood cells. In this case, a CT scan of the abdomen helps to differentiate between complicated and uncomplicated diseases.
First, a brief overview of the anatomy of the large intestine – especially the Teniae coli. In contrast to the small intestine and rectum, the large intestine contains only one complete layer of muscles, the inner ring layer. The outer longitudinal layer is concentrated in the three Teniae coli.
The Teniae coli – the mesocolic, free and omental Teniae coli – are three separate longitudinal ligaments (taeniae means “ligament” in Latin) of smooth muscle on the outside of the ascending, transverse, descending and sigmoid colon. The Teniae coli contract lengthways to produce haustra, the bulges in the large intestine. The ligaments converge at the root of the appendix and on the rectum.
It is believed that the pathogenesis of diverticular disease involves structural abnormalities of the colon wall and impaired bowel motility.
The spaces between the circular ligaments of Teniae coli are weak points in the intestine and the most common sites of diverticulosis. According to Matrana and Margolin, microscopic studies have shown muscle atrophy in these areas that are naturally prone to hernia. In addition, those with diverticulosis show a marked thickening of the sphincter muscle, a shortening of the tenie and a narrowing of the lumen compared to healthy controls. The thickening of the muscle is not due to hypertrophy, but rather to abnormal elastin deposition. This leads to a shortening of the muscle layer and an accordion-like folding effect called an accordion, especially in the case of pronounced diverticula.
Problems with intestinal motility
Colonic motility problems include excessive segmental muscle contractions, increased intraluminal pressure, and the separation of the colonic lumen into chambers. “The increased incidence of diverticula in the sigma is explained by Laplace’s law that pressure is proportional to wall tension and inversely proportional to bowel radius. Since the sigma is the smallest diameter segment of the colon, it is also the segment with the highest intraluminal pressures, “says StatPearls.
For more than 50 years, experts thought that a low-fiber diet led to diverticulosis. However, recent research has found that a low-fiber diet may not be a factor. One study also found that a high-fiber diet with more frequent bowel movements may be linked to a higher risk of developing diverticulosis.
Some studies have suggested that genetics could play a role in the development of diverticulosis and diverticulitis. Other factors that may also play a role are certain drugs, including nonsteroidal anti-inflammatory drugs and steroids; Sedentary lifestyle; Obesity; and smoking.
Most patients with diverticulosis have no symptoms, and the condition itself is not dangerous. However, some people may experience unexplained abdominal pain or cramps, changes in bowel habits (constipation or diarrhea), or blood in the stool. Any bleeding associated with diverticulosis is painless. A diagnosis of diverticulosis is suspected if a patient has any of these symptoms.
Complications of Diverticulitis
Diverticulitis can come on suddenly and cause other problems, such as:
- Abscesses – painful, swollen, infected, and pus-filled areas just outside the colon wall that can be accompanied by nausea, vomiting, fever, and severe tenderness in the abdomen. Abscesses can be treated with antibiotics, but may require drainage if they don’t respond.
- Perforations – small tears or holes in a pouch in the large intestine.
- Peritonitis – inflammation or infection of the lining of the abdomen. Pus and stool leaking through a perforation can cause peritonitis.
- Fistula – an abnormal passageway or tunnel between two organs or between an organ and the outside of the body. The most common forms of fistula with diverticulitis occur in women between the colon and bladder or between the colon and vagina.
- Bowel obstruction – a partial or complete blockage of the movement of food or stool through your bowels.
The goal of treating diverticulosis is to prevent the pouches from causing symptoms or problems.
High fiber diet
Although a high-fiber diet may not prevent diverticulosis, it can prevent symptoms or problems in people who already have diverticulosis. A doctor may suggest increasing your dietary fiber. This should be done slowly to reduce the chance of gas and pain.
A health care provider may suggest taking a fiber product such as methyl cellulose (Citrucel) or psyllium (Metamucil) one to three times a day. These products are available as powders, pills, or wafers and contain 0.5 to 3.5 grams of fiber per dose. Fiber products should be taken with at least 8 ounces of water.
Some studies have shown that mesalamine (Asacol) taken daily or in cycles can help reduce symptoms that may occur with diverticulosis, such as abdominal pain or gas. Other studies have shown that the antibiotic rifaximin (Xifaxan) can also help with diverticulosis symptoms.
Some studies have shown that probiotics can help with diverticulosis symptoms and prevent diverticulitis. Probiotics are living microorganisms that are said to have health benefits when consumed. They are found in yogurt and other fermented foods and supplements. They can be helpful by altering the microbial balance in the intestines and have anti-inflammatory effects. The use of probiotics in diverticulosis is an active topic in current clinical research.
Michele R. Berman, MD, is a pediatrician and medical journalist. She was educated at Johns Hopkins, Washington University in St. Louis, and St. Louis Children’s Hospital. Her mission is both journalistic and educational: to cover common diseases that affect rare people and to summarize the evidence-based medicine behind the headlines.