A Closer Look at the Colon Condition That Hospitalized the Pope

On Sunday evening, Pope Francis was operated on for a colon disease called “symptomatic stenotic diverticulitis”. The elective surgery, performed at the Gemelli Hospital in Rome, took about three hours, according to the Holy See Press Office.

Francis, 84, is generally healthy and this is the first time he has been hospitalized since he became Pope in 2013. He is vigilant and breathing alone, according to a Vatican spokesman, and is expected to be for. stay in the hospital seven days.

To 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, about seven days in the hospital,” said Dr. Philip S. Barie, Professor Emeritus of Surgery at Weill Cornell Medical College. “That’s probably out of caution and the fact that he’s 84.”

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

It starts out as a mild condition called diverticulosis, which is essentially a collection of bags in the wall of the colon, usually on the left side. Diverticulosis is very common: around two in three people have the pouches by the time they are 60 or 70 years old.

For most people, the bags do not cause any problems, other than occasional blood in the stool. But about 10 to 15 percent of people with diverticulosis have their pouches clogged and inflamed, which can bring patients to the emergency room.

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

Diverticulitis affects 3 to 5 million people each year in the United States alone and is usually treated with only antibiotics. However, in some severe cases, surgery may be required – which is also not uncommon.

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

It is believed that diverticulosis is the result of a Western diet that is low in fiber and high in processed foods. It is common in the United States and certain countries like Scotland, and much less common in African countries, for example.

Dr. Barie recalled a senior United Nations official from Africa who had been stationed in New York for more than 20 years. The man’s dietary change during this time was enough to “develop a disease that he probably would not have gotten if he had stayed in his home country,” said Dr. Barie.

A low-fiber diet, especially if too little water is consumed, can lead to constipation. “The stool becomes smaller, harder, and harder to pass. In order to pass it, you have to create more pressure in your colon and push more, ”explained Dr. Barie.

The pressure causes the lining of the colon to sag. And if leftovers like cucumber or tomato seeds get stuck in the bags, they can ignite the food.

Each episode of diverticulitis can gradually scar and thicken the colon wall, eventually shrinking the passage about 90 percent from its typical width to just a quarter of an inch – the diameter of a # 2 pencil.

If there is no movement at all, the patient can develop a colon obstruction that requires emergency surgery. But more often, people like Francis have symptoms that are so debilitating that they consider elective surgery.

Diverticulosis causes few symptoms and can go unnoticed. The symptoms become noticeable in the inflamed state of diverticulitis.

The spectrum of symptoms varies depending on the severity of the stricture and its location in the colon. If symptoms are bad enough, doctors may order a colonoscopy to identify the stricture.

Francis could have had gas or abdominal cramps and possibly had enough pain to consider elective surgery, said Dr. Barie.

In milder stages, diverticulitis can be treated on an outpatient basis with oral antibiotics. More severe cases may require hospitalization and intravenous antibiotics.

Some severe cases could be treated long-term with only medical-grade fiber, probiotics to alter gut bacteria, and an aspirin-like drug that reduces inflammation in the colon. Dr. Flum is leading a large study comparing medical management to surgery. The start of the study was delayed by the pandemic, but is expected to be completed by 2025.

When a patient has had many attacks of diverticulitis, surgery is often the only option. “Until it gets to the point where it’s scarred and too tight, we don’t have a lot of medical options,” said Dr. Flum.

In operations like the one Francis most likely underwent, doctors remove a portion of the colon called the sigmoid colon, where diverticulitis is most common. You can remove up to a few inches to a foot of the colon and sew the cut ends.

The Pope’s operation was most likely performed using laparoscopy, which requires far fewer incisions than traditional methods. Still, up to one in five people who have this surgery can develop infections, so “infection prevention is an important thing,” said Dr. Barie.

For the first month, Francis can follow a low residue diet aimed at avoiding large bowel movements. Then he may be advised to eat a high-fiber diet to prevent diverticulitis elsewhere in the colon – although this is unlikely at his age as it takes time to develop.

It’s also a good sign that he’s fine overall. In 1957, an upper lung lobe was removed from him due to complications from tuberculosis. And for the past few years, his breathing seemed to be strained while he was speaking. In 2019, a cataract was removed from him and he was vaccinated against the coronavirus in January.

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