The modified Hinchey classification is based on CT scan findings and is used to categorize diverticulitis, as well as help to guide appropriate. The modified Hinchey classification is based on computed tomography scan findings and is used to categorize diverticulitis, as well as help to guide appropriate. Clinical staging by Hinchey’s classification is based on computed tomography findings and directed toward selection of the proper surgical procedure when.
|Published (Last):||20 September 2007|
|PDF File Size:||7.26 Mb|
|ePub File Size:||16.19 Mb|
|Price:||Free* [*Free Regsitration Required]|
The classification is I-IV:. Only a few classifications for diverticular disease were revealed. The Standards Task Force. Additionally, a difference was made between confined pericolic inflammation or phlegmon stage Ia and a confined pericolic abscess stage Ib.
Acute left colonic diverticulitis—compared performance of computed tomography and water-soluble contrast enema: Patients may have serious complaints, but interventions can usually be postponed to an elective setting. Laparoscopic peritoneal lavage for perforated colonic diverticulitis: Elective resection for diverticular disease: Routine colonoscopy divulges the majority finds of asymptomatic diverticular disease.
It is now thought that after a conservatively treated episode, diverticular disease usually follows a rather benign course and that complications occur mostly at first presentation [ 103233 ].
Role of endoscopy in the management of acute diverticular bleeding. Massive diverticular bleeding might be approached endoscopically clipping, coagulation, or adrenaline injections or even endovascular coilingbut in most centers, a laparoscopic sigmoid resection is probably the final resolution. In this approach, the CT scan provides the physician guidance in the treatment of acute complications, as well as a prognostic factor in the development of chronic complications after a first conservatively treated episode [ divertixulitis ].
Methods An extensive literature analysis was performed using the PubMed database. Colonoscopy enables diveryiculitis for histological diagnosis, and cessation of diverticular bleeding may be attempted by endoscopic measures, such as clipping, coagulation, or adrenaline injections [ 18 ].
The much more detailed information provided by CT scans led earlier to modifications of the original Hinchey classification. This modification also implied the use of new treatment strategies, such as CT-guided percutaneous drainage of abscesses. Elective surgery after acute diverticulitis. This procedure may relieve symptoms or function as a bridge to elective surgery.
Review of current classifications for diverticular disease and a translation into clinical practice
Can superselective embolization be definitive for colonic diverticular hemorrhage? In order to prevent complicated disease after two episodes of acute diverticulitis, it has been considered good practice for years to perform elective sigmoid resection after two episodes of symptomatic diverticulitis and even doing so after one episode in the younger patients [ 31 ].
New physiopathological and therapeutic approaches to diverticular disease of the colon. International Journal of Colorectal Disease. Author information Article notes Copyright and License information Disclaimer. Yet, this does not discount the initial subjective complaints.
An individual approach, weighing symptoms and peri-operative risks on a case by case basis, seems the most appropriate policy [ 3435 ]. Also, the role of elective or preventive sigmoid resection will be addressed. Is there a need for another classification? Free gas associated with localized or generalized ascites and possible peritoneal wall thickening. Introduction Diverticular disease of the sigmoid colon is a common condition in Western society.
Advances in Surgery Table 6 Proposed classification.
The combination of the following symptoms should be suspected: Hence, inSher et al. The Hinchey Classification is a simple staging system useful to determine the severity of acute diverticulitis. Another German classification published in by Siewert et al. A more hazardous course has been suggested. Minimally invasive and surgical management strategies tailored to the severity of acute diverticulitis. Methods This article reviews all current classifications for diverticular disease.
Moreover, none of the classifications seem to sufficiently embrace the entire spectrum of the disease. Given a useful classification system ought to guide clinical decision making and management, this review serves to combine the available classifications with current knowledge of practice into a more useful practice parameter for treating diverticular disease.
The management of diverticular disease in young patients remains controversial. Since the mids, laparoscopic sigmoid resections for diverticular disease have gained popularity. Therefore, elective sigmoid resections should be restricted for use in treating complicated disease, such as symptomatic stenosis, fistulas to a hollow organ, or recurrent diverticular bleeding.
This article is an orphanas no other articles link to it. We acknowledge diverticluitis the introduction of still another classification could be even more confusing. In this classification, complications are certified by severity and therapeutic options.
Initial prescriptions are often antibiotics and an easily digestible diet, although no clear evidence exists for both their beneficial actions.
The planning of an elective operation makes it possible to do a proper preoperative work-up to prevent unwelcome surprises during surgery.
This page was last edited on 30 Marchat Complications such as stenosis, fistula, or recurrent diverticular bleeding are clear indications for an elective sigmoid resection, but also the prevention of perforated diverticulitis by performing an elective sigmoid resection has been standard policy for several decades.
In these severe circumstances, acute surgical intervention is warranted. Civerticulitis amounts of mucus or blood loss are generic signs of inflammation, whereby colonoscopy has to rule out other inflammatory bowel diseases or colon cancer.
Same hospitalization resection for acute diverticulitis.