Page created on September 12, 2021. Last updated on April 11, 2022 at 10:42
Introduction
For introduction, epidemiology, etiology, and pathomechanism, see the corresponding pathology 2 topic. For clinical features, and diagnosis and evaluation, see the corresponding internal medicine topic (61).
Hinchey classification of complicated diverticulitis
- Stage I – Pericolic abscess
- Stage II – Walled-off pelvic abscess
- Stage III – Generalised purulent peritonitis
- Stage IV – Generalised faeculent peritonitis
Treatment
Diverticular bleeding can be treated endoscopically during colonoscopy.
The treatment of uncomplicated diverticulitis is antibiotics and painkillers. Mild cases may be managed outpatient.
Complicated diverticulitis is treated according to the Hinchey stage. Hinchey I and II diverticulitis are treated with percutaneous drainage of the abscess, while Hinchey III and IV are treated surgically (usually with the Hartmann operation).
In the Hartmann operation, the diseased colon (usually sigmoid) is removed. The rectal stump is then oversewn, while a colostomy is formed for the proximal colonic stump. This colostomy may be reversed in the future (after months/year), when the proximal colonic stump and rectal stump may be re-joined.
All patients with diverticulitis should undergo colonoscopy after the acute illness, often 6 weeks later, to assess the extent of diverticulosis and to rule out malignancy.
No treatment can cure diverticulosis, but it’s important to prevent progression and recurrence with a high-fibre diet, weight reduction, etc.