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Hinchey Classification is used to describe perforations of the colon due to diverticulitis.The classification was developed by Dr. E John Hinchey (1934–present), a general surgeon at the Montreal General Hospital and professor of surgery at McGill University.
This is a shortened version of the ninth chapter of the ICD-9: Diseases of the Digestive System. It covers ICD codes 520 to 579. The full chapter can be found on pages 301 to 328 of Volume 1, which contains all (sub)categories of the ICD-9. Volume 2 is an alphabetical index of Volume 1.
Uncomplicated acute diverticulitis is defined as localized diverticular inflammation without any abscess or perforation. [46] Complicated diverticulitis additionally includes the presence of abscess, peritonitis, obstruction, stricture and/or fistula. 12% of patients with diverticulitis present with complicated disease. [47]
The inflammation of the epiploic appendages normally resolves on its own for most patients. It is possible however uncommon for acute epiploic appendagitis to result in adhesion, bowel obstruction, intussusception, intraperitoneal loose body, peritonitis, and/or abscess formation. [2] Treatment consists of reassurance of the patient and analgesics.
CT scan showing extensive diverticulosis of the sigmoid colon Diverticular disease Whole slide of a transverse section of the left colon with diverticulosis. Diverticulosis is defined by the presence of multiple pouches (diverticula) in the colon. [22] In people without symptoms, these are usually found incidentally during other investigations.
Computed tomography of the abdomen is not routinely necessary, but may show thickening or inflammation in the distal colon (sigmoid colon) with associated diverticulosis. Treatment may consist of antibiotics, aminosalicylates (mesalamine), or prednisone. In rare cases, surgery with segmental resection may be considered.
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About 10% of cases have a more serious cause including gallbladder (gallstones or biliary dyskinesia) or pancreas problems (4%), diverticulitis (3%), appendicitis (2%) and cancer (1%). [2] More common in those who are older, ischemic colitis , [ 5 ] mesenteric ischemia , and abdominal aortic aneurysms are other serious causes.