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A Closer Look at the Colon Condition That Hospitalized the Pope

On Sunday evening, 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.

Francis, 84, is healthy overall and this is the first time he has been admitted to a hospital since becoming pope in 2013. He is alert and breathing on his own, according to a Vatican spokesman, and is expected to remain at the hospital for seven days.

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

“I am a little surprised, but not concerned, 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 an abundance of caution and the fact that he’s 84.”

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 collection of pouches in the colon wall, usually on the left side. Diverticulosis is extremely common: About two out of three people have the pouches once they get to their 60s or 70s.

In most people, the pouches don’t cause any problems, aside from occasional blood in the stool. But in about 10 percent to 15 percent of people with diverticulosis, the pouches become blocked and inflamed, which can land the patients in the emergency room.

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

Diverticulitis affects 3 million to 5 million people each year in the United States alone, and is usually treated with just antibiotics. But in some severe cases, it can require surgery — which is also not uncommon.

“Diverticulitis is one of the most common reasons for colon surgery in the United States,” 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. The modification to the man’s diet over 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, particularly when compounded by not drinking enough water, can result in 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 explained.

The pressure causes the lining of the colon to pouch out. And when food particles like cucumber or tomato seeds become wedged in the pouches, they can inflame the lining.

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

If there is no movement at all, the patient can 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 may go unnoticed. The symptoms become apparent 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 the symptoms are bad enough, doctors may order a colonoscopy that would identify the stricture.

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

Is surgery the only option?

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

Some severe cases could be managed long-term with just medical-grade fiber, probiotics to change the bacteria in the gut, and an aspirinlike drug that tamps inflammation down in the colon. Dr. Flum is leading a large trial that will compare medical management with surgery. The trial’s launch was delayed by the pandemic, but is expected to be complete by 2025.

If a patient has suffered many attacks of diverticulitis, surgery often becomes the only choice. “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 said.

In surgeries like the one Francis most likely underwent, doctors excise a part of the colon called the sigmoid colon where diverticulitis is most common. They might remove as much as a few inches to a foot of the colon and stitch the cut ends.

What might recovery look like for Francis?

The pope’s surgery was most likely done using laparoscopy, which involves much less cutting than traditional methods. Still, as many as one in five people who have this surgery can develop infections, so “infection prevention is an important thing,” Dr. Barie said.

For the first month, Francis may be on a low-residue diet designed to not make big stools. He may then be advised to eat a high-fiber diet to prevent diverticulitis elsewhere in the colon — although that is unlikely at his age because it takes time to develop.

It is also a good sign that he is in good health overall. In 1957, he had an upper lobe of his lung removed because of 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.

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