Diverticulitis: What's Ailing Brock Lesnar?

With the news yesterday former UFC heavyweight champion Brock Lesnar was suffering from a second bout with diverticulitis, it's time to explore what the condition is, what causes it and what it all means. Lest we forget, Lesnar is adamant this iteration of the flare up is not as serious as the first. In fact, as I noted when it happened, Lesnar initial battle with this condition put more than his career in jeopardy: his life was on the line.

Let's recall what Matt Pitt, board-certified physician, had to say about diverticulitis and Lesnar's specific condition:

Diverticulitis is an infection involving the colon, generally the extreme end portion known as the distal and sigmoid colon. The normal course of the disease involves low-grade fevers, loose bloody stools and abdominal pain followed shortly by relatively easy diagnosis, treatment with oral antibiotics and swift recovery. A previously healthy individual would certainly be laid up for a week or so, and a professional fighter might be unfit for high-level training for as long as a month. But Lesnar’s diverticulitis wasn’t diagnosed early, and he was absolutely right when he stated on "SportsCenter" that he very nearly died.

The complication Lesnar suffered was a bowel perforation, a pus-forming infection eroding through the wall of the colon. If the perforation is contained, medical treatment and percutaneous drainage generally result in full recovery. If the perforation is not contained, if large volumes of pus and stool spill into the abdominal cavity, then emergency surgery is the only hope for survival and death is an expected outcome. At best a patient could expect to lose all or part of his colon and be incapacitated for years. It appears, from what Lesnar explained on "SportsCenter," that he was diagnosed on the razor-thin border between these two extremes.

If he had gone to surgery, all or part of the colon would have been removed. The healthy bowel would be diverted to a hole in the abdominal wall -- a "fistula" -- so stool could have been drained into a colostomy bag. After a period of recovery, taking many months, it’s possible the colostomy could be reversed -- allowing normal function of the bowel -- but the recovery from this second surgery would again require several months. If reversing the colostomy were not feasible, Lesnar would have been bound to wear a colostomy bag for life; training for MMA, much less competing, would have been impossible.

Lesnar's current predicament is a choice of surgery or increased level of antibiotics, both with significant opportunity cost. I'm not entirely sure surgery this time out would mirror precisely what Dr. Pitt previously outlined, but clearly it's the more extreme option of the two. Here's how surgery is generally performed:

Diverticulitis surgery can be done in two ways: through a primary bowel resection or through a bowel resection with colostomy. Both bowel resections may be done in the traditional way or by laparoscopic surgery.[14] The traditional bowel resection is made using an open surgical approach, called colectomy. During a colectomy, the patient is placed under general anesthesia in order to make sure that the patient will not feel any pain and he or she will be completely asleep during the procedure. A surgeon performing a colectomy will make a lower midline incision in the abdomen or a lateral lower transverse incision. The diseased section of the large intestine is removed and then the two healthy ends are sewn or stapled back together. A colostomy may be performed when the bowel has to be relieved of its normal digestive work as it heals. A colostomy implies creating a temporary opening of the colon on the skin surface and the end of the colon is passed through the abdominal wall and a removable bag is attached to it. The waste will be collected in the bag.[15]

However, most of the surgeons prefer performing the bowel resection laparoscopically mainly because the postoperative pain is reduced and the patient's recovery is faster. The laparoscopic surgery is a minimally invasive procedure in which three to four smaller incisions are made in the abdomen or navel.

All colon surgery involves only three maneuvers that may vary in complexity depending on the region of the bowel and the nature of the disease which are the retraction of the colon, the division of the attachments to the colon and the dissection of the mesentery.[16] After the resection of the colon, the surgeon normally divides the attachments to the liver and the small intestine. After the mesenteric vessels are dissected, the colon is divided with special surgical staplers that close off the bowel while cutting between the staple lines.

Lesnar said it himself: his health is his first priority, fighting again his second. Although athletes of his caliber are generally able to recover from complicated and superficial ailments more easily than their sedentary counterparts in society, one has to think the invasiveness of either surgical procedure carries significant risk of upholding Lesnar's first priority at the expense of the second.

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