Diverticulitis

Diverticulitis

Hinchey Classification

Stage 0 – Clinically mild diverticulitis with just colonic wall thickening on the CT

Stage 1a – Pericolic inflammation or phlegmon, and pericolic tissue changes on CT

Stage 1b – Evidence of formation of a pericolic or mesocolic abscess

Stage 2 – Formation of pelvic, retroperitoneal or distant abdominal abscess

Stage 3 –  Presence of widespread generalised purulent peritonitis

Stage 4 – Presence of widespread feculent peritonitis

Alternatively, diverticulitis can be classified as complicated or uncomplicated: 

Cases are considered complicated if they have: positive blood culture, septic shock, abscess >5cm diameter or perforation.

Management of Diverticulitis

Uncomplicated diverticulitis – classically does not require antibiotics and can be treated with bowel rest. Augmentin can be considered, however, if: 

• Immunocompromised
• Right-sided diverticulitis
• Failure to improve after 72 hours

Complicated diverticulitis requires IV antibiotics (ampicillin, gentamicin and metronidazole)

• Percutaneous drainage can be considered with abscesses >4cm
• Surgical intervention (resection with primary anastomosis or Hartmann’s procedure) can be considered on a case by case basis and those refractory to medical therapy

Complications of Diverticulitis

• Bowel obstruction
• Fistula formation (i.e. colovesical, colovaginal, enterocolic)
• Frank perforation