Management of Hinchey II diverticulitis

Table 1 Clinical classification of diverticulitis (adapted from Köhler et al[7])

Grade	Clinical features	Symptoms
I	Symptomatic uncomplicated disease	Fever, abd pain, CT evidence of diverticulitis
II	Recurrent symptomatic disease	Recurrence of above symptoms
III	Complicated disease	GI bleeding
		Phlegmon
		Abscess
		Peforation-purulent/faecal peritonitis
		Stricture
		Fistula
		Obstruction

Table 2 Modified hinchey classification (adapted from Wasvery et al [11,12])

Modified Hinchey classification
0	Mild clinical diverticulitis
Ia	Confined pericolic inflammation-phlegmon
Ib	Confined pericolic abscess
II	Pelvic, intrabdominal or retrocolic abscess
III	Generalized purulent peritonitis
IV	Faecal peritonitis
Fistula	Colo-vesical/-vaginal/-enteric/-cutaneous
Obstruction	Large/small bowel obstruction

Table 3 CT staging of diverticulitis (adapted from Ambrosetti et al[19])

Ambrosetti's CT staging of diverticulitis
Moderate diverticulitis	Severe diverticulitis
Localised sigmoid wall thickening (5 mm or more)	Abscess
Inflammation of pericolic fat	Extraluminal air/contrast

Table 4 Results of a retrospective audit from our institution over a five-year period

Series of diverticulitis case	n
CT confirmed diverticulitis (n)	69
Hinchey type II (n)	28
Average size of abscesses (cm)	5
Average size of abscess for PCD (cm)	7
Rate of surgical intervention (%)	46

Table 5 Results showing the total number, numbers drained, age, site and size (average for PCD) of abscesses from studies in literature

Name	Total	Drained	Mean age yr (/range)	Site of abscess			Size for PCD (cm)
				Paracolic	Pelvic	Others
Kumar et al[31]	30	12	39	15	5	10	6.5
Stabile et al[26]	19	19	63.8	8	9	2	8.7
Kaiser et al[11]	99	16	-	74	25	-	7.1
Ambrosetti et al[30]	73	19	66.9	45	28	-	6.7
Brandt et al[13]	66	34	71	-	-	-	6
Bahadursingh et al[32]	25	10	61	9	9	7	-
Siewert et al [33]	30	4	54.2	-	-	-	5.9
Neff et al[28]	16	16	42-86	2	13	1	> 5
Alvarez et al[34]	59	-	64	37	22	-	-

Table 6 Results showing the total number, numbers drained, response to conservative treatment and details of emergency/elective/semi-elective surgery from studies in literature

Name	Total	Drained	Antibiotics ± PCD	Surgery same admission	Elective/semi-elective
Kumar et al[31]	30	12	17	5	-
Stabile et al[26]	19	19	-	3	14
Mueller et al[27]	24	21	1	6	12
Kaiser et al[11]	99	16	56	23	20
Ambrosetti et al[30]	73	19	30	18	25
Brandt et al[13]	66	34	21	15	28
Siewert et al[33]	30	4	17	-	13
Cinat et al[37]	13	13	-	5	-
Saini et al[29]	17	8	-	1	7
Alvarez[34]	59	-	33	26	-