Anybody who’s had a diverticulitis flare remembers the first one. The pain shows up on the left side and doesn’t behave like a stomachache. It gets loud.
Mark Houston lived with that for two decades. Diagnosed in 2003, one flare a year at first, then two, then a December that put him in the hospital for eleven days. On February 20 he had part of his colon removed at Monument Health by Dr. Steven Donahue, a colorectal surgeon in Rapid City. Months later, he got Donahue into the studio for Doc Talk.
What it actually is
Diverticulosis is the presence of little pockets in the colon wall. Donahue calls them pockets with patients, because that’s what they look like. Colonoscopies turn them up in people who feel fine.
Diverticulitis is what happens when one gets plugged. It swells, seals off, and a tiny hole lets bacteria seep out. That’s the inflammation.
Why so many people get it is still partly theory. Genetics, diet, obesity, bad luck. Fiber comes up fast. The recommendation runs 25 to 35 grams a day, and Donahue points out what happens when you flip over a package in your kitchen. Two grams. Three grams. Per serving. He recommends a daily supplement to most patients, and takes one himself.
The old nut and seed rule, the one that had Houston avoiding strawberries for twenty years? Largely debunked. Doctors repeat it because nobody has a better answer yet.
Warning signs
Diverticulitis runs on a spectrum. A mild twinge on one end, a free perforation with sepsis and emergency surgery on the other.
Signs that something real is happening:
- Severe pain, usually left side
- Fever and chills
- Blood in the stool
- Sudden severe constipation from a swollen colon wall
- Or the opposite, severe diarrhea from colonic spasm
“This is not a routine stomach ache,” Donahue said.
Houston backs that up. “You’ll know, trust me. If you have a flare up, it’s unmistakable.”
When surgery enters the conversation
The old rule was a count. Two or three episodes, time to operate. That’s gone. “Everyone has different goals and what they want,” Donahue said.
A flare every five years, handled with antibiotics, might be something you can live with. Then he asks about your life. Do you travel? Are you a truck driver hundreds of miles from a hospital?
Some findings move faster. A perforation, an abscess, an obstruction, a fistula.
Houston had the last one. A colovesical fistula, a connection eroded between his colon and bladder after years of inflammation. It brings frequent UTIs, bladder pain, sometimes stool passing through urine. It doesn’t heal on its own.
“The first time my family doctor said that, I knew then,” Houston said. “Yep, I’m having surgery.”
He expected a thumb and forefinger when he asked how much came out. Donahue used both palms. About twelve inches, under a quarter of the colon.
The robot in the room
Monument Health uses the da Vinci system. Four arms, a fifth incision for the assistant, one extraction site.
What surprised Houston was where the surgeon sits: in a corner, behind the anesthesia machine, facing away from the patient.
“It’s quite bizarre,” Donahue said. “You put your eyes in the machine, there’s microphones in both of your ears, you’ve got two eyeballs and you’re looking through the camera.”
The arms articulate at the wrist, so he can turn corners and reach deep into the pelvis. He controls all four himself, camera included. “You get to operate twice as much, essentially.”
The open version meant an incision from pubis to sternum. Houston’s healed in weeks, with less scar tissue inside, which matters if you ever need surgery again.
The bag question
It’s the first thing out of most patients’ mouths. Donahue tells everyone there’s a risk, then explains that avoiding a bag is the whole point of operating electively instead of waiting for an emergency. A fistula doesn’t automatically mean you get one. Even when a colostomy is necessary, it’s almost always reversible.
Houston woke up without one.
Say it out loud
Donahue hears the same nervous apology all day. People sit down and say they’re sorry, this is awkward. He waves it off.
“I saw twenty five people today, and I had the same discussion twenty five times,” he said. “Chances are you’ve got a friend that had this too. They didn’t talk about it at your dinner party.”
More than one flare a year? Have the conversation. Deciding on surgery isn’t the point of that appointment.
“I’ll tell you the risks of surgery, I’ll tell you the risks of not having surgery, and then it’s your decision,” Donahue said.
