Since Hinchey's traditional classification for perforated diverticulitis in , several modifications and new grading systems have been. Download scientific diagram| The Hinchey Classification of perforated diverticulitis. from publication: Treatment Options for Perforated Colonic Diverticular. E J Hinchey et al. 3 proposed a classification for acute diverticulitis, that has been variously adapted, and is useful not only in academia but also in outlining.
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Treatment recommendations include conservative approaches with observation and dietary modifications along with antibiotic treatment, abscess drainage, and surgery.
A differentiated treatment dependent on disease stage is agreed upon in current hinchey diverticulitis and international guidelines [ 45 ]. However, the specific choice of treatment varies and no consensus seems to be present at this point, especially when managing the most severe cases of acute diverticulitis with bowel perforation, where urgent treatment is required to prevent sepsis and hinchey diverticulitis death.
Hinchey Classification - Wikipedia
We aimed to evaluate current treatments for perforated acute diverticulitis based on the available literature in order to determine the most effective and protective approach.
Hinchey diverticulitis Acute, complicated diverticulitis is hinchey diverticulitis into four stages according to the Hinchey classification, based upon preoperative findings of abscesses and intestinal perforation Table 1 [ 3 ].
In the most severe cases, abscess perforation leads to purulent peritonitis Hinchey 3 and diverticula rupture to faecal peritonitis Hinchey 4 Figure 1.
CT scan of perforated diverticulitis with diverticula thin arrows and free abdominal air thick arrows. The standard treatment hinchey diverticulitis the Hartmann procedure hinchey diverticulitis of the diverticula affected colonic segment, closure of the rectal stump, and formation of an end colostomy [ 6 ].
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In the elective setting, a laparoscopic approach is preferred since it provides less pain and a faster recovery [ 5 ]. In acute settings, however, the choice of surgical hinchey diverticulitis varies greatly around the world, where the availability of necessary expertise for acute laparoscopic procedures can be a limiting factor, especially during night hinchey diverticulitis.
The Different Surgical Procedures Over the years, hinchey diverticulitis surgical methods have been explored. A review summarizing former surgical methods for acute diverticulitis described hinchey diverticulitis use of a three-stage procedure with firstly diverting colostomy and suture of the intestinal perforation, secondary colonic resection, and lastly stoma reversal [ 7 ].
Also, colonic resections with primary anastomosis with or without a proximal diverting ileostomy and on-table colonic lavage [ 8 ] have been evaluated. Experiences with Hinchey diverticulitis Lavage Within the last decades, a more conservative approach of peritoneal lavage has been investigated as an alternative to colonic hinchey diverticulitis.
In this procedure, pus is aspirated typically by laparoscopic access followed by abdominal lavage with heated saline and drainage for some days after the procedure [ 9 ]. So far, no randomized controlled clinical trial has been published comparing peritoneal lavage with colonic resection in the treatment of perforated diverticulitis.
Hinchey diverticulitis of the largest studies on peritoneal lavage was published in [ 9 ]. This prospective multicenter study included patients hinchey diverticulitis radiological verified complicated diverticulitis Hinchey 2—4.
Hinchey classification of acute diverticulitis | Radiology Reference Article |
Patients were preoperatively treated with iv fluid and antibiotics before undergoing laparoscopic peritoneal lavage and drainage.
Antibiotic treatment hinchey diverticulitis for minimum 72 hours postoperatively and oral intake of fluids was restricted on the first postoperative day. Of the 92 patients treated with lavage, three patients died two of multiple organ failure, one of pulmonary embolismwhereas two patients were immunosuppressed hinchey diverticulitis a renal transplant.
The clinical resolution was absent in two patients, who proceeded to colonic resection one patient and radiologic abscess drainage one patient. At the following colonoscopy, diverticular disease and inflammatory resolution were confirmed in all patients experiencing resolution after peritoneal lavage.
Within a hinchey diverticulitis follow-up period of 36 months, two patients were readmitted with acute diverticulitis, both managed with antibiotic treatment. A prospective database study followed 88 patients with perforated diverticulitis Hinchey 2—4 after receiving acute treatment of laparoscopic colonic resection or hinchey diverticulitis peritoneal lavage with drainage [ 10 ].
Patients undergoing diagnostic laparoscopies were excluded due to a criterion on preoperative CT verification of the perforation.
A total of 47 patients hinchey diverticulitis peritoneal lavage and 41 underwent a Hartmann procedure. The distribution of demographics, disease severity Hinchey 2—4and comorbidities hinchey diverticulitis comparable between the groups.
One lavage procedure was converted to a Hartmann procedure. Furthermore, postoperative complications differed significantly between 4.