A closer look at the colon condition that hospitalized the Pope

Garry Miller writes:
On Sunday night, Pope Francis underwent surgery for a colon condition called “symptomatic stenotic diverticulitis.” The elective surgery, performed at the Gemelli hospital in Rome, lasted about three hours, according to a statement by the press office of the Holy See.

The 84-year-old Francis is in general good health and this is the first time he has been admitted to a hospital since he became pope in 2013. He is alert and breathing on his own, according to a Vatican spokesman, and is expected to stay in the hospital longer. seven days.

For a man his age, the illness, surgery and expected recovery sound reasonable, doctors said, and he should be able to make a full recovery.

“I’m a little surprised, but not worried, for about seven days in the hospital,” said Dr. Philip S. Barie, emeritus professor of surgery at Weill Cornell Medical College. “That is probably due to great caution and the fact that he is 84 years old.”

What is diverticulitis?

Despite its intimidating name, symptomatic stenotic diverticulitis is a relatively common and treatable disorder.

It begins as a mild condition called diverticulosis, which is essentially a buildup of bags on the wall of the colon, usually on the left side. Diverticulosis is extremely common: about two out of three people have the bags once they reach their 60s or 70s.

For most people, the bags do not cause any problems other than occasional blood in the stool. But in about 10 to 15 percent of people with diverticulosis, the bursae become blocked and inflamed, which can land patients in the emergency room.

This inflammation, called diverticulitis, “is also incredibly common,” said Dr. David R. Flum, Professor of Surgery at the University of Washington in Seattle.

Diverticulitis affects 3-5 million people each year in the United States alone, and is typically treated with antibiotics alone. But in some serious cases, it may require surgery, which is also not uncommon.

“Diverticulitis is one of the most common reasons for colon surgery in the United States,” said Dr. Flum said.

What Causes Diverticulitis?

Diverticulosis is believed to be the consequence of a Western diet that is low in fiber and high in processed foods. It is common in the United States and in certain countries like Scotland, and much rarer in African nations, for example.

Dr. Barie recalled a senior United Nations official from Africa who had been assigned to New York for more than 20 years. Modifying the man’s diet during that time was enough for him to “develop a disease that he probably would not have developed had he stayed in his native country,” Dr. Barie said.

A low fiber diet, especially when combined with not drinking enough water, can lead to constipation. “Stool becomes smaller, harder, and more difficult to pass, so to evacuate it, you need to create more pressure in the colon and more pressure,” said Dr. Barie explained.

The pressure causes the lining of the colon to come off. And when food particles like cucumbers or tomato seeds get stuck in the bags, they can inflame the lining.

Each episode of diverticulitis can progressively scar and thicken the wall of the colon, eventually reducing the passage by about 90 percent of its typical width to just a quarter of an inch, the diameter of a No. 2 pencils.

If there is no movement, the patient may develop a large bowel obstruction, which requires an emergency operation. But more often, people like Francis experience symptoms debilitating enough to consider elective surgery.

What are the symptoms of diverticulitis?

Diverticulosis causes few symptoms and can go unnoticed. Symptoms are evident in the inflamed state of diverticulitis.

The range of symptoms varies depending on the severity of the stricture and its location in the colon. If symptoms are severe enough, doctors may order a colonoscopy that identifies the stricture.

Francis may have experienced abdominal bloating or cramping and may have had enough pain to consider elective surgery, Dr. Barie said.

Is surgery the only option?

In its milder stages, diverticulitis can be treated with oral antibiotics as an outpatient treatment. More severe cases may require hospitalization and IV antibiotics.

Some severe cases could be treated long-term with just medical-grade fiber, probiotics to change bacteria in the gut, and an aspirin-like drug that tightens inflammation in the colon. Dr. Flum is leading a large trial that will compare medical management with surgery. The launch of the test was delayed by the pandemic, but it is expected to be complete in 2025.

If a patient has suffered many bouts of diverticulitis, surgery often becomes the only option. “By the time it gets to the point where it’s scarred and it’s too narrow, we don’t have a lot of medical options,” said Dr. Flum said.

In surgeries like the one Francis likely underwent, doctors remove a part of the colon called the sigmoid colon, where diverticulitis is most common. They can remove up to a few inches to a foot from the colon and sew the cut ends together.

What would Francis’s recovery be like?

Most likely, the Pope’s surgery was performed laparoscopically, which involves much less cutting than traditional methods. Still, one in five people who have this surgery can develop infections, so “preventing infections is an important thing,” Dr. Barie said.

For the first month, Francis can follow a low-residue diet designed not to produce large stools. Then, you may be advised to eat a high-fiber diet to prevent diverticulitis in other parts of the colon, although this is unlikely at your age because it takes time to develop.

It is also a good sign that you are in good general health. In 1957, an upper lobe of his lung was removed due to complications from tuberculosis. And in recent years, his breathing has seemed labored during speeches. He had a cataract removed in 2019. And he was immunized against the coronavirus in January.