Diverticulitis Specialist In Bozeman, Montana

What is diverticulitis?

Diverticula are small pouches that can form in the wall of the colon. The presence of these pouches is called diverticulosis.

Diverticulitis occurs when one or more diverticula become inflamed and, in some cases, infected. The condition most often affects the sigmoid colon, which is located in the lower left side of the abdomen.

Some episodes remain uncomplicated and resolve with conservative treatment. Others lead to serious complications, including:

• Abscess
• Colon perforation
• Peritonitis
• Sepsis
• Intestinal obstruction or stricture
• Fistula formation

A fistula is an abnormal connection between the colon and another organ. Diverticulitis may produce a fistula involving the bladder, vagina, small intestine, skin, or another segment of bowel.

What symptoms does diverticulitis cause?

The most common symptom is steady pain in the lower left abdomen. Other symptoms may include:

• Left lower abdominal pain
• Fever or chills
• Nausea or vomiting
• Constipation
• Diarrhea
• Bloating
• Loss of appetite
• Changes in urinary symptoms when the bladder is involved

What causes diverticulitis?

The exact cause is not always clear. Diverticulitis likely develops through a combination of structural changes in the colon, inflammation, altered bacteria within the gut, and individual risk factors.

Factors associated with diverticulitis include:

• Family history and genetics
• Obesity
• Smoking
• Physical inactivity
• A diet low in fiber and high in highly processed foods
• Certain medications, including steroids, opioids, and nonsteroidal anti-inflammatory drugs
• Impaired immune function

Diverticulitis is not caused by eating nuts, seeds, popcorn, or corn. These foods do not need to be routinely avoided.

How is diverticulitis treated?

Treatment depends on the severity of the episode and whether complications are present.

Many patients with uncomplicated diverticulitis can recover at home with temporary dietary modification, hydration, pain control, and close follow-up. Antibiotics are used selectively rather than automatically and are more likely to be recommended when symptoms are severe, infection is suspected, or the patient has impaired immune function or other significant health risks.

Patients with an abscess may require image-guided drainage. Hospital treatment may be necessary for severe pain, inability to tolerate fluids, systemic infection, perforation, obstruction, or other complications.

After recovery, patients are often advised to increase dietary fiber, maintain regular bowel habits, exercise, avoid smoking, and work toward a healthy body weight.

A colonoscopy may be recommended after an episode to confirm the diagnosis and exclude other conditions, depending on the patient’s age, previous colonoscopy history, imaging findings, and clinical circumstances.

When is surgery recommended for diverticulitis?

Surgery is considered when diverticulitis causes complications or repeatedly interferes with a patient’s health and quality of life.

Common reasons for surgery include:

• Recurrent attacks that substantially disrupt daily life
• Persistent pain or inflammation between episodes
• Abscess
• Fistula
• Colon narrowing or obstruction
• Perforation
• Difficulty excluding cancer
• Diverticulitis in a patient with impaired immune function
• Failure of nonoperative treatment

The decision is individualized. The number of previous attacks alone does not determine whether surgery is necessary.

What does surgery for diverticulitis involve?

Surgery removes the diseased segment of colon, most commonly the sigmoid colon, and reconnects the healthy ends of the bowel.

Dr. Zehnpfennig performs diverticulitis surgery using advanced robotic and laparoscopic techniques. Through four small incisions, he removes the diseased colon and creates a new colorectal connection entirely within the abdomen while minimizing trauma to the abdominal wall.

Natural-orifice specimen extraction is feasible for nearly all patients undergoing elective surgery for diverticulitis. This technique allows the diseased segment of colon to be removed through a natural opening rather than through a larger abdominal extraction incision. Compared with conventional abdominal specimen extraction, this approach is associated with less postoperative pain, fewer wound-related complications, and faster recovery.¹

Most elective patients do not require a colostomy. Temporary or permanent colostomy is generally reserved for severe emergencies, extensive infection, unstable patients, or situations in which safely reconnecting the bowel is not possible.

What is recovery like after diverticulitis surgery?

Dr. Zehnpfennig follows an enhanced recovery pathway built around minimally invasive surgery, multimodal pain control, and early reintroduction of diet.

Many patients meet discharge criteria on the first postoperative day. Selected patients may qualify for same-day discharge. Recovery continues at home, with progressive return to normal activity after two weeks.

To learn more about advanced treatment for diverticulitis, call the office or request an appointment online.

1. Mui J, Sarofim M, Cheng E, Gilmore A. Laparoscopic natural orifice specimen extraction for diverticular disease: a systematic review. Surgical Endoscopy. 2025;39:3049–3056. 

2. Wolthuis AM, et al. Randomized clinical trial of laparoscopic colectomy with or without natural-orifice specimen extraction. British Journal of Surgery. 2015;102:630–637.