This article has been cited by other articles in PMC. Abstract Introduction Diverticular disease of the sigmoid colon prevails in Western society. Its presentation may vary greatly per individual patient, from symptomatic diverticulosis to perforated diverticulitis. Since publication of the original Hinchey classification, several modifications and new grading systems have been developed. Yet, new insights in the natural history of the disease, the emergence of the computed tomography scan, and new treatment modalities plead for evolving classifications.
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Diet[ edit ] People may be placed on a low fibre diet. Evidence tends to run counter to this, with a review finding no evidence for the superiority of low fibre diets in treating diverticular disease, and that a high-fibre diet may prevent diverticular disease. With CT scan evidence of abscess, fistula, or intestinal rupture with peritonitis, antibiotics are recommended and routinely used.
Surgery[ edit ] Indications for surgery are abscess or fistula formation; and intestinal rupture with peritonitis. The timing of the elective surgery is determined by evaluating factors such as the stage of the disease, the age of the person, their general medical condition, the severity and frequency of the attacks, and whether symptoms persist after the first acute episode.
In most cases, elective surgery is deemed to be indicated when the risks of the surgery are less than the risks of the complications of the diverticulitis. Elective surgery is not indicated until at least six weeks after recovery from the acute event.
This first stage of surgery is performed on people if they have a well-vascularized, nonedematous and tension-free bowel. The proximal margin should be an area of pliable colon without hypertrophy or inflammation. The distal margin should extend to the upper third of the rectum where the taenia coalesces. Not all of the diverticula-bearing colon must be removed, since diverticula proximal to the descending or sigmoid colon are unlikely to result in further symptoms.
Either may be done by the traditional laparotomy or by laparoscopic surgery. During a colectomy the person is placed under general anesthesia. A surgeon performing a colectomy will make a lower midline incision in the abdomen or a lateral lower transverse incision. The diseased section of the large intestine is removed, and then the two healthy ends are sewn or stapled back together. A colostomy may be performed when the bowel has to be relieved of its normal digestive work as it heals.
A colostomy implies creating a temporary opening of the colon on the skin surface, and the end of the colon is passed through the abdominal wall with a removable bag attached to it. The waste is collected in the bag. The laparoscopic surgery is a minimally invasive procedure in which three to four smaller incisions are made in the abdomen or navel.
Furthermore, laparoscopic lavage was as safe as resection for perforated diverticulitis with peritonitis. The maneuvers are the retraction of the colon, the division of the attachments to the colon and the dissection of the mesentery.
After the mesenteric vessels are dissected, the colon is divided with special surgical staplers that close off the bowel while cutting between the staple lines.
Bowel resection with colostomy[ edit ] When excessive inflammation of the colon renders primary bowel resection too risky, bowel resection with colostomy remains an option. The bowel resection with colostomy implies a temporary colostomy which is followed by a second operation to reverse the colostomy.
The surgeon makes an opening in the abdominal wall a colostomy which helps clear the infection and inflammation. The colon is brought through the opening and all waste is collected in an external bag.
Epidemiology[ edit ] Diverticulitis most often affects the elderly. In Western countries, diverticular disease most commonly involves the sigmoid colon 95 percent of people with diverticulitis. The number of people affected with diverticular disease increased from an estimated 10 percent in the s to between 35 and 50 percent by the late s. Less than 5 percent of those aged 40 years and younger are affected by diverticular disease.
Left-sided diverticular disease involving the sigmoid colon is most common in the West, while right-sided diverticular disease involving the ascending colon is more common in Asia and Africa. September Archived from the original on 13 June Retrieved 12 June
In een review van meerdere diagnostische onderzoeken zijn de eigenschappen van verschillende diagnostische testen vergeleken [Bemelman ]. Druk- en loslaatpijn blijken door hun relatief hoge sensitiviteit gepoolde waarde respectievelijk 0,91 en 0,89 maar relatief lage specificiteit 0,60 en 0,57 geschikt om een peritonitis uit te sluiten. Uit de data van het onderzoek konden geen voorspellende waarden van de verschillende testen worden berekend. Terug Noot De waarde van een CRP-bepaling bij vermoeden van diverticulitis Het CRP is een acutefase-eiwit dat binnen vier tot zes uur na het ontstaan van een ontsteking of infectie verhoogd in het bloed aanwezig is.
Colonic Diverticular Disease
Diet[ edit ] People may be placed on a low fibre diet. Evidence tends to run counter to this, with a review finding no evidence for the superiority of low fibre diets in treating diverticular disease, and that a high-fibre diet may prevent diverticular disease. With CT scan evidence of abscess, fistula, or intestinal rupture with peritonitis, antibiotics are recommended and routinely used. Surgery[ edit ] Indications for surgery are abscess or fistula formation; and intestinal rupture with peritonitis.
Critical appraisal of laparoscopic lavage for Hinchey III diverticulitis
This article is an orphan , as no other articles link to it. Please introduce links to this page from related articles ; try the Find link tool for suggestions. February Hinchey Classification is used to describe perforations of the colon due to diverticulitis. The classification was developed by Dr. Diverticulosis the presence of bowel diverticula is an essentially ubiquitous phenomenon.