Diverticular disease of the colon

Question 1

Explain the Hinchey classification of diverticular disease

Answer 1

1 - Pericolic abscess or phlegmon
2 - Pelvic, intraabdominal, or retroperitoneal abscess
3 - Generalised purulent peritonitis
4 - Generalised fecal peritonitis (stool moves out of the colon into the abdomen)

Question 2

Explain the modified Hinchey classification for diverticular disease

Answer 2

1 - Pericolic abscess
2a - Distant abscess amendable to percutaneous drainage
2b - Complex ascess associated with fistula
3 - Generalised purulent peritonitis
4 - Fecal peritonitis

Question 3

How does diverticulitis present

Answer 3

Left iliac fossa pain

Question 4

What are the investigations for diverticulitis

Answer 4

FBC - WCC, Hb
U&E - Have to determine kidney function before doing CT
CRP
Albumin level - <25 means decreased healing function

Imaging:
- X-ray: presence of free air or not
- Tender abdomen = peritonitis(needs surgery)
- CT scan: can see which part of bowel affected. Allows patient to be graded and determines treatment

Question 5

What are the contraindications for anastamosing the colon

Answer 5

Low albumin <25
Haemodynamically unstable patient
High counts of infection and contamination

Question 6

What is the treatment for Hinchey 1

Answer 6

Antibiotics
Pain medications
If unable to eat - liqued diet or no food for few days

Question 7

What is treatment of hinchey 2

Answer 7

Abscess <4cm
- Antibiotics
- Pain medications
- Monitor patient daily

Ascess >4cm
- Antibiotics
- Pain medications
- Drainage under US guidance
- Monitor patient daily (WCC, CRP)

Question 8

What is the management of Hinchey 3/4

Answer 8

Surgery

Hinchey 3:
- Clean out puss and wash out
- Resecting portion of colon
- Colostomy or anastamosing depending on patient

Hinchey 4:
- Wash out stool
- Colostomy