A Closer Look at the Colon Condition That Hospitalized the Pope

On Sunday night, Pope Francis underwent surgical procedure for a colon situation referred to as “symptomatic stenotic diverticulitis.” The elective surgical procedure, carried out at the Gemelli hospital in Rome, lasted about three hours, in accordance with a press release by the press workplace of the Holy See.

Francis, 84, is wholesome general and that is the first time he has been admitted to a hospital since turning into pope in 2013. He is alert and respiration on his personal, in accordance with a Vatican spokesman, and is anticipated to stay at the hospital for seven days.

For a person of his age, the illness, surgical procedure and anticipated restoration all sound cheap, medical doctors mentioned, and he ought to be capable of make a full restoration.

“I am a little surprised, but not concerned, about seven days in the hospital,” mentioned Dr. Philip S. Barie, professor emeritus of surgical procedure at Weill Cornell Medical College. “That’s probably out of an abundance of caution and the fact that he’s 84.”

What is diverticulitis?

Despite its intimidating identify, symptomatic stenotic diverticulitis is a comparatively widespread and treatable dysfunction.

It begins as a light situation referred to as diverticulosis, which is basically a group of pouches in the colon wall, normally on the left facet. Diverticulosis is extraordinarily widespread: About two out of three folks have the pouches as soon as they get to their 60s or 70s.

In most individuals, the pouches don’t trigger any issues, apart from occasional blood in the stool. But in about 10 p.c to 15 p.c of individuals with diverticulosis, the pouches change into blocked and infected, which may land the sufferers in the emergency room.

This irritation, referred to as diverticulitis, “is incredibly common as well,” mentioned Dr. David R. Flum, professor of surgical procedure at the University of Washington in Seattle.

Diverticulitis impacts three million to five million folks every year in the United States alone, and is normally handled with simply antibiotics. But in some extreme circumstances, it may well require surgical procedure — which can also be not unusual.

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

What causes diverticulitis?

Diverticulosis is believed to be the consequence of a Western weight loss program that’s low in fiber and excessive in processed meals. It is widespread in the United States and in sure international locations like Scotland, and far rarer in African nations, for instance.

Dr. Barie recalled a senior United Nations official from Africa who had been assigned to New York for greater than 20 years. The modification to the man’s weight loss program over that point was sufficient for him to “develop a disease that he probably would not have developed had he stayed in his native country,” Dr. Barie mentioned.

A low-fiber weight loss program, notably when compounded by not ingesting sufficient water, can lead to constipation. “The stools become smaller, they’re harder, and they’re harder to pass, and so to pass them, you have to generate more pressure in your colon, and more squeeze,” Dr. Barie defined.

The stress causes the lining of the colon to pouch out. And when meals particles like cucumber or tomato seeds change into wedged in the pouches, they’ll inflame the lining.

Each episode of diverticulitis can progressively scar and thicken the colon wall, finally shrinking the passage by about 90 p.c from its typical width to only one quarter of an inch — the diameter of a No. 2 pencil.

If there isn’t any motion at all, the affected person can develop a big bowel obstruction, which requires an emergency operation. But extra usually, folks like Francis expertise signs debilitating sufficient to think about elective surgical procedure.

What are the signs of diverticulitis?

Diverticulosis causes few signs and will go unnoticed. The signs change into obvious in the infected state of diverticulitis.

The vary of signs varies, relying on the severity of the stricture and its location in the colon. If the signs are unhealthy sufficient, medical doctors could order a colonoscopy that may establish the stricture.

Francis could have skilled bloating or stomach cramping and will have been in sufficient ache to think about the elective surgical procedure, Dr. Barie mentioned.

Is surgical procedure the solely possibility?

In its milder levels, diverticulitis could be managed with oral antibiotics as an outpatient remedy. More extreme circumstances could require hospitalization and intravenous antibiotics.

Some extreme circumstances might be managed long-term with simply medical-grade fiber, probiotics to alter the micro organism in the intestine, and an aspirinlike drug that tamps irritation down in the colon. Dr. Flum is main a big trial that may examine medical administration with surgical procedure. The trial’s launch was delayed by the pandemic, however is anticipated to be full by 2025.

If a affected person has suffered many assaults of diverticulitis, surgical procedure usually turns into the solely alternative. “By the time it gets to the point where it’s scarred down and too narrow, we don’t have a lot of medical options,” Dr. Flum mentioned.

In surgical procedures like the one Francis most definitely underwent, medical doctors excise part of the colon referred to as the sigmoid colon the place diverticulitis is most typical. They would possibly take away as a lot as a number of inches to a foot of the colon and sew the minimize ends.

What would possibly restoration seem like for Francis?

The pope’s surgical procedure was most definitely achieved utilizing laparoscopy, which entails a lot much less chopping than conventional strategies. Still, as many as one in 5 individuals who have this surgical procedure can develop infections, so “infection prevention is an important thing,” Dr. Barie mentioned.

For the first month, Francis could also be on a low-residue weight loss program designed to not make huge stools. He could then be suggested to eat a high-fiber weight loss program to forestall diverticulitis elsewhere in the colon — though that’s unlikely at his age as a result of it takes time to develop.

It can also be a very good signal that he’s in good well being general. In 1957, he had an higher lobe of his lung eliminated due to issues from tuberculosis. And in recent times, his respiration has appeared labored throughout speeches. He had a cataract eliminated in 2019. And he was immunized in opposition to the coronavirus in January.