What is Hinchey classification of diverticulitis?
The universally accepted is the Hinchey classification[8], which descriptively characterises the various stages of diverticulitis and its acute complications. Type I and Type II refer to inflammatory phlegmon and paracolic abscesses while type III and IV refer to purulent and faeculent peritonitis respectively.
How do you classify diverticulitis?
Classification
- stage 0: clinical: mild clinical diverticulitis.
- stage Ia: clinical: confined pericolic inflammation or phlegmon.
- stage Ib: clinical: pericolic or mesocolic abscess.
- stage II: clinical: pelvic, distant intra-abdominal or retroperitoneal abscess.
- stage III: clinical: generalized purulent peritonitis.
- stage IV:
What pathophysiological change occurs in diverticulitis?
Pathogenesis. The pathogenesis of diverticulitis is believed to be erosion of the wall of the diverticulum. It is worsened by an increase in intraluminal pressure or food remnants. Diverticula are protrusions of the mucosa and serosa intestinal layers and occur more often on the left side than the right side.
What is acute diverticulitis?
Acute diverticulitis is inflammation due to micro-perforation of a diverticulum. The diverticulum is a sac-like protrusion of the colon wall. Diverticulitis can present in about 10% to 25% of patients with diverticulosis. Diverticulitis can be simple or uncomplicated and complicated.
What is uncomplicated diverticulitis?
Uncomplicated diverticular disease is defined as the presence of diverticula in the absence of complications such as perforation, fistula, obstruction and/or bleeding.
What are the symptoms of acute diverticulitis?
The signs and symptoms of diverticulitis include:
- Pain, which may be constant and persist for several days. The lower left side of the abdomen is the usual site of the pain.
- Nausea and vomiting.
- Fever.
- Abdominal tenderness.
- Constipation or, less commonly, diarrhea.
How serious is acute diverticulitis?
If you don’t treat it, diverticulitis can lead to serious complications that require surgery: Abscesses, collections of pus from the infection, may form around the infected diverticula. If these go through the intestinal wall, you could get peritonitis. This infection can be fatal.
What causes acute uncomplicated diverticulitis?
Acute uncomplicated diverticulitis (AUD) is generally felt to be caused by obstruction and inflammation of a colonic diverticulum and occurs in about 4–5% of patients with diverticulosis.
How serious is uncomplicated diverticulitis?
The mortality rate in uncomplicated diverticulitis is negligible with appropriate conservative therapy. Complicated diverticulitis requiring surgery may lead to death in approximately 5% of patients. Perforation of the bowel with resulting peritonitis increases the risk of death to 20%.
What is the modified Hinchey Classification for diverticulitis?
The modified Hinchey classification is based on CT scan findings and is used to categorize diverticulitis, as well as help to guide appropriate interventions. [ 3]
Which is the best grading scale for diverticulitis?
The Hinchey classification requires operative intervention yet remains the established scoring system for acute diverticulitis. This is a pilot study to compare the AAST grading scale for acute colonic diverticulitis with the traditional Hinchey classification.
Which is less predictive AAST or Hinchey scores?
The AAST and Hinchey scores were less predictive for ICU admission, readmission, and mortality with c-statistics of less than 0.80. Conclusion: The AAST grading of acute diverticulitis is equivalent to the modified Hinchey classification in predicting procedural intervention and complications.
What kind of surgery is needed for modified Hinchey?
Modified Hinchey stages II-IV require hospitalization, nothing by mouth, IV antibiotics, and percutaneous abscess drainage; surgical consultation and elective procedure for patients in stage II, and urgent surgical evaluation and resection for those in stage III and IV.