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. Door een korte halfwaardetijd vier tot zeven uur reageert het snel op veranderingen.
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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. Methods This article reviews all current classifications for diverticular disease.
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. Keywords: Diverticulitis, Diverticular disease, Classification Introduction Diverticular disease of the sigmoid colon is a common condition in Western society. Its presentation among patients may vary from symptomatic diverticulosis to perforated diverticulitis. Although diverticular disease is more common among elderly patients, a dramatic rise of its incidence is seen in the younger age groups [ 2 ].
Furthermore, depending on the severity of the disease, the treatments for the various presentations of the disease will differ. Accordingly, diagnostic tools, indications for surgery as well as treatment modalities have been evolving, resulting in more options in the therapy for diverticular disease. Unfortunately, these different classifications of diverticular disease have led to conflicting terminology in current literature. Moreover, none of the classifications seem to sufficiently embrace the entire spectrum of the disease.
This calls for a thorough review and a new parameter. The current classifications of diverticular disease are based on clinical, radiological, or operative findings, yet most lack a translation into daily clinical practice.
Given a useful classification system ought to guide clinical decision making and management, this review serves to combine the available classifications with current knowledge of practice into a more useful practice parameter for treating diverticular disease.
Methods An extensive literature analysis was performed using the PubMed database. Only a few classifications for diverticular disease were revealed. In most publications, the results of a clinical study on imaging or treatment modalities are described, and rarely the proposal of a new classification system.
A second analysis using manual cross reference search of the bibliographies of relevant articles located studies not found in the first search. All articles in English, German, and Dutch have been included.
A total of nine classifications and modified classifications for diverticular disease were collected.
Classifications A proper classification system can improve mutual communication between doctors of different specialties and support clinical decision making.
Uniform classification in clear subgroups of diverticular disease could help the clinician in predicting outcomes and prognosis more accurately. In , Hinchey et al.
This most widely used classification was actually based on an earlier clinical division of acute diverticulitis published by Hughes et al. Since the introduction of the computed tomography CT scan in the s, this imaging modality has established itself as the primary diagnostic tool in the assessment of diverticular disease see Fig.
The much more detailed information provided by CT scans led earlier to modifications of the original Hinchey classification. Subcategories could be defined by taking the radiological findings into account. Hence, in , Sher et al. This modification also implied the use of new treatment strategies, such as CT-guided percutaneous drainage of abscesses. Table 1.
Published by Baishideng Publishing Group Inc. All rights reserved. This article has been cited by other articles in PMC. Abstract Laparoscopic lavage and drainage is a novel approach for managing patients with Hinchey III diverticulitis. However, this less invasive technique has important limitations, which are highlighted in this systematic review. We performed a PubMed search and identified 6 individual series reporting the results of this procedure. An analysis was performed regarding treatment-related morbidity, success rates, and subsequent elective sigmoid resection.
Review of current classifications for diverticular disease and a translation into clinical practice
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.
Critical appraisal of laparoscopic lavage for Hinchey III diverticulitis
Percutaneous drainage of abscess if greater than cm Consider colonoscopy 6 weeks after attack if no recent colonoscopy performed Surgical resection if symptoms progress following percutaneous drainage or during evolution of diverticular complications Prompt resuscitation and operative optimization Systemic antibiotic therapy Surgical resection with consideration of fecal diversion. Laparoscopic washout in selected cases Hinchey IV Prompt resuscitation and operative optimization Systemic antibiotic therapy Surgical resection with fecal diversion Colonoscopy and biopsy to exclude colonic adenocarcinoma. If biopsies inconclusive, treat as adenocarcinoma Surgical resection with anastomosis and consideration of proximal diverting ostomy Acute large bowel obstruction Prompt resuscitation and operative optimization Surgical resection with likely fecal diversion Colonoscopy and biopsy to exclude colonic adenocarcinoma. Consideration of: cystoscopy to exclude cancer and assess proximity of fistula to ureters Examination under anaesthesia of vagina to identify external fistula opening. Medical optimization for surgery Surgical resection with consideration of temporary fecal diversion. In cases of persistent bleeding, depending on local institution: Colonoscopy and clipping in persistent bleeding CT angiogram and angioembolisation Subtotal colectomy and end ileostomy indicated in patients with persistent bleeding not controlled with endoscopic and angiographic interventions.
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.