What is the recommended definitive treatment for Hinchey stage IB and II?
The general treatment option for these stages (Ia & II) starts from conservative management to CT guided percutaneous drainage (PCD) and then on to surgery based on progression of the disease with reliance on clinical and laboratory parameters.
Which is the most commonly used classification for diverticular disease?
The Hinchey classification has traditionally been used in international literature to distinguish four stages of perforated disease (see Table 1). This most widely used classification was actually based on an earlier clinical division of acute diverticulitis published by Hughes et al. (see Fig.
What is diverticulitis classification?
Stage I disease: Phlegmon or localized pericolic or mesenteric abscess. Stage II disease: Walled-off pelvic, intra-abdominal, or retroperitoneal abscess. Stage III disease: Perforated diverticulitis causing generalized purulent peritonitis.
What is the standard treatment for diverticulitis?
A typical oral antibiotic regimen is a combination of ciprofloxacin (or trimethoprim-sulfamethoxazole) and metronidazole. Monotherapy with moxifloxacin or amoxicillin/clavulanic acid are appropriate for outpatient treatment of uncomplicated diverticulitis.
Can uncomplicated diverticulitis become complicated?
Diverticulitis is divided into simple and complicated forms. Simple can be treated as an outpatient, and complicated may require hospitalization. Complicated diverticulitis occurs when the inflammation evolves into a few patterns.
What are the surgical indications for colon resection for acute diverticulitis?
The decision to undergo surgical intervention is made on a case-by-case basis. The indication for colon resection is recurrent attacks or complicated diverticulitis, which is characterized by perforation, obstruction, abscess, or fistula.
What does surgery for diverticulitis entail?
The surgery involves removing the sigmoid colon as well as a small area of the rectum. Because diverticula can also occur in other parts of the intestine, it’s usually not possible to remove all of them. After the affected section of intestine has been removed, the ends are sewn back together again.
What kind of surgery is done for diverticulitis?
The most common type of surgery for all forms of diverticular disease is called sigmoid resection (sigmoidectomy). The sigmoid colon is the section of the large intestine that comes just before the rectum, at the end of the bowel.
What is considered 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.
When is surgery recommended for diverticulitis?
Your NYU Langone gastroenterologist may recommend surgery if symptoms of diverticulitis haven’t improved after nonsurgical treatment; if a perforation or fistula, a connection that forms between the intestines and another organ, develops in the colon wall; or if a diverticular pouch ruptures.
When do you use the term Hinchey Classification?
Hinchey Classification is used to describe perforations of the colon due to diverticulitis.
What kind of surgery is needed for Hinchey IV?
Hinchey IV – feculent peritonitis. (Intestinal perforation allowing feces into abdominal cavity). The Hinchey classification is useful as it guides surgeons as to how conservative they can be in emergency surgery. Recent studies have shown with anything up to a Hinchey III, a laparoscopic wash-out is a safe procedure,…
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.
Why was Hinchey’s Classification of diverticulitis so important?
Hinchey’s classification of diverticulitis has become the most widespread system and while the Hinchey score may currently have less clinical relevance as it did in his time, its publication and eventual adoption marked a practice-changing paradigm shift in the way diverticulitis is viewed and managed today.