Management of Hinchey II diverticulitis.
Colonic diverticulosis can either be asymptomatic or present with complications resulting in significant morbidity and mortality. A key presentation of complicated disease is abscess formation (Hinchey type II). The natural course of this is unclear and therefore treatments range from conservative approach with antibiotics and percutaneous guided drainage (PCD) to surgery. There is no clear consensus on the exact management strategy. A Medline based literature search specifically looking at studies dealing with Hinchey type II diverticulitis and its management was carried out. For comparison, five-year retrospective data of diverticular abscesses from our institution was collected and the outcome analysed. Various studies have looked into this aspect of the disease, elaborating on the significance of the size and location of the abscesses, the role of PCD, recurrence rates and the controversies regarding the need for elective surgery. Conservative treatment with antibiotics alone is effective in a majority of cases with a role for PCD in large safely accessible abscesses. Variable recurrence rates have been reported in literature and elective surgery should be planned for selected groups of patients.
Soumian
Soni
S
Department of Surgery, Good Hope Hospital, Heart of England NHS, Foundation Trust, Rectory Road, Sutton Coldfield, Birmingham, B75 7RR, United Kingdom. sonisoumian@yahoo.com
Thomas
Sudeep
S
Mohan
Prasoon P
PP
Khan
Nadia
N
Khan
Zeeshan
Z
Raju
Tirumala
T
D000038:Abscess / Q000209:etiology*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003082:Colectomy; D003108:Colonic Diseases / Q000209:etiology*; D004239:Diverticulitis, Colonic / Q000150:complications* / Q000628:therapy*; D006801:Humans; D012189:Retrospective Studies; D055502:Secondary Prevention
D000900:Anti-Bacterial Agents