Antibiotics have been the mainstay of therapy for most patients with Patients with clinically mild diverticulitis, typically with Hinchey stage 0. Acute left sided colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in acute setting. A World Society of. Introduction: Acute diverticulitis (AD) is increasingly seen in Emergency services. The application of a reliable classification is vital for its safe and effective management. The Hinchey system is a surgical classification and as such it is not.
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Review of current classifications for diverticular disease and a translation into clinical practice
Int J Colorectal Dis ;25 Drains were placed in dw of the patients treated with antibiotics, with a good response. An extensive literature analysis was performed using the PubMed database.
At our service, after radiological diagnosis, the type of AD is graded using the mNeff classification Table I. Seven of the eleven patients completed home treatment, representing a success rate of Primary anastomosis after intraoperative colonic lavage vs.
Eur J Intern Med ; A proper classification system can improve mutual communication between doctors of different specialties and support clinical decision making.
Its presentation may vary greatly per individual patient, from symptomatic diverticulosis to perforated diverticulitis. Grade Ib 49, 8. The surgical management of acute diverticulitis.
Eur J Gastroenterol Hepatol ; Outpatient management of acute uncomplicated diverticulitis. In the case of a purulent peritonitis, either laparoscopic sigmoid resection with primary anastomosis with or without defunctioning stoma or even laparoscopic lavage may be considered in selected cases. Risk of emergency colectomy and colostomy in patients with diverticular disease. Recurrence rates at minimum 5-year follow-up: The Hinchey system is a surgical classification and as such it is not particularly useful, since nowadays very few ADs require surgery This modification clasificxcion implied the use of new treatment strategies, such as CT-guided percutaneous drainage of abscesses.
Diverticulitis aguda no complicada: Acknowledgments Open Access This article is distributed diverticulltis the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author s and source are credited. Therefore, laparoscopic sigmoid resection may well be divertlculitis procedure of choice for patients requiring elective resection for diverticular disease.
Open in a separate window. KlarenbeekNiels de KorteDonald L. After a first attack, preventive measures have to be taken into account, such as high-fiber diet, weight loss, and treatment of comorbid conditions. Is the Hinchey classification the best guide for surgical decision making?
In most classifications, post-inflammatory changes like stenosis or fistulas are not included. In Januarythese beneficial effects were confirmed by a randomized controlled trial; the short-term results showed that a laparoscopic approach delivered a significant Comorbility is a major determinant of severity in acute diverticulitis.
Br J Surg ;99 4: The much more detailed information provided by CT scans led earlier to modifications of the original Hinchey classification. Quantitative variables were described using means and standard deviations or medians and ranges when the distribution was not normal. Recent studies have shown with anything up to a Hinchey III, a laparoscopic wash-out is a safe procedure,  avoiding the need for a laparotomy and stoma formation.
In spite of these limitations, we conclude that the mNeff classification, together with clinical data on SIRS and comorbidity, can help to define an effective and safe management protocol for any patient diagnosed with AD. The protocol is similar to others presented by other groups in our country and elsewhere in Europe for the treatment of uncomplicated AD and its management at home 15,19,36,37and it also defines the management of complicated AD. In these severe circumstances, acute surgical intervention is warranted.
Am Surg ;65 7: Patients may have serious complaints, but interventions can usually be postponed to an elective setting.
World J Gastroenterol ; Support Center Support Center. Introduction Diverticular disease of the sigmoid colon is a common condition in Western society. A second analysis using manual cross reference search of the bibliographies of hincheg articles located studies not found in the first search.
Patients with subclinical complaints or recurrent hospital admission should not be considered differently because both groups will fully recover with conservative measures. Of diiverticulitis 21 stage Ia patients Between February and Februarycases of AD were diagnosed at our center women and men.
Patients without comorbidities or SIRS who tolerate oral feeding and have no pain are discharged under a home health care scheme and seen at the outpatient service after two weeks. The decision to insert an abdominal drain was taken in light of the radiological criteria of the size and accessibility of the abscess. Discussion and a proposal of a duverticulitis classification This review of the current classification systems for a condition as complex as clasificavion disease raises the question: In our study, of AD patients Treatment The wide spectrum of diverticular disease warrants a differentiated approach to the different manifestations.
Prevention of complications and symptomatic recurrences in diverticular disease with mesalazine: Acute episodes of stage A digerticulitis can mostly be resolved with antibiotics and a low residue diet.