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The modified Hinchey classification is based on CT scan findings and is used to categorize diverticulitis, as well as help to guide appropriate. The modified Hinchey classification is based on computed tomography scan findings and is used to categorize diverticulitis, as well as help to guide appropriate. Clinical staging by Hinchey’s classification is based on computed tomography findings and directed toward selection of the proper surgical procedure when.

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Additional advantages of MRI over CT scan are its better visualization of fistulae and the possibility of virtual colonoscopy, thereby making invasive colonoscopy unnecessary.

This article reviews all current classifications for diverticular disease. Since the mids, laparoscopic sigmoid resections for diverticular disease have gained popularity.

British Journal of Surgery 1January Acute episodes of stage A diverticulitis can mostly be resolved with antibiotics and a low residue diet. In addition, high-risk patients, such as those immune compromised, using of NSAIDs and other immune suppressants or experiencing chronic renal failure, hinchhey be good candidates for early elective sigmoid resection.

In recent years, magnetic resonance imaging MRI has gained popularity, because it lacks the ionizing radiation of diverticupitis CT scan, yet matches its sensitivity and specificity [ 19 ]. CT scan images resembling the four Hughes stages.

Hinchey Classification for Acute Diverticulitis – Doctor Guidelines

Elective resection for diverticular disease: This page was last edited on 30 Marchat Yet, this does not discount the initial subjective complaints. Since publication of the original Hinchey classification, several modifications and new grading systems have been developed. Epidemiology of perforated colonic diverticular disease. Stage B includes diverticuliits complications of diverticular disease, such as symptomatic stenosis, fistulas to hollow organ, recurrent self-limiting diverticular bleeding, and incapacitating complaints.


In cases of stenosis or recurrent rectal blood loss, it is advisable to hinchdy a colonoscopy to rule out cancer.

For instance, impaired passage of a stool divertoculitis suggestive for a stenosis, in which a colonoscopy can differentiate between post-diverticulitis stenosis or cancer; diverticular bleeding is the most common cause of recurrent rectal blood loss, but again cancer should be ruled out by a colonoscopy; and pneumaturia is pathognomic for a colovesical fistula, usually a CT scan will reveal its pathway. A second analysis using manual cross reference search of the bibliographies of relevant articles located studies not found in the first search.

The Hinchey Classification is a simple staging system useful to determine the severity of acute diverticulitis. Uniform classification in clear subgroups of diverticular disease could help the clinician in predicting outcomes and prognosis more accurately.

Hinchey Classification

IV Massive pneumoperitoneum and free fluid. In contrast, opponents account the longer lifespan responsible for more recurrences and complications and thereby a higher cumulative risk of emergency surgery. Recently, these recommendations have been challenged because new data on the natural history of diverticulitis has shown that most perforations do not occur after recurrences, but at the first attack of acute diverticulitis [ 11 ].

Some authors proposed modifications to the classification. The proposed three-stage model provides a renewed and comprehensive classification system for diverticular disease, incorporating up-to-date imaging and future treatment modalities. Diagnosis and treatment of diverticular disease: One must consider that a large number of patients with complaints of pain in the left lower quadrant, fever, and soiling are probably out of clinical sight, consulting only their general practitioner.


Routine colonoscopy divulges the majority finds of asymptomatic diverticular disease. Another German classification published in by Siewert et al.

Hinchey classification of acute diverticulitis | Radiology Reference Article |

III Small amounts of free air and fluid. In this classification, complications are certified by severity and therapeutic options.

This last group of divertjculitis covers mainly those young patients who are incapacitated by recurrent attacks and hospital admissions, which prevent them from having normal working careers and social life.

Result A three-stage model is advanced for a renewed and comprehensive classification system for diverticular disease, incorporating up-to-date imaging and treatment modalities.

Review of current classifications for diverticular disease and a translation into clinical practice

Elective surgery after acute diverticulitis. The classification is I-IV:. Complications such as stenosis, fistula, or recurrent diverticular bleeding are clear indications for an elective sigmoid resection, but also the prevention of perforated diverticulitis by performing an elective sigmoid resection has been standard policy for several decades.

Generalized fecal peritonitis — Risk of death: However, if it is not contained it leads to faecal contamination of the peritoneal cavity faecal peritonitis which is often fatal. Large abscesses C1 and perforated disease C4 are severe complications, but also massive diverticular C3 bleeding and total bowel obstruction C2 are entitled to acute interventions.

Hughes classification Hughes et al.