Classification of diverticulitis of the colon

Colonic diverticula are pouch-like structures that develop in the wall of the colon, most commonly in the sigmoid and left colon, but can also involve the entire colon. When these diverticula become infected, it causes diverticulitis. Medical imaging and colonoscopy play a very important role in diverticulitis of the colon, the means above not only help diagnose and evaluate the colonoscopy accurately, but also help guide treatment and treatment. treatment and monitoring progress.

Because the formation process takes a long time, diverticular disease is common in the elderly. However, cases occurring in the age of 30 or older are not uncommon. Sometimes the colon, especially the sigmoid colon, is filled with diverticula. This disease is common in Western societies.
The disease is very rare in rural areas of Africa or India. Food in these regions often consists of unprocessed foods and nuts that are rich in fiber. Therefore, a high-fiber diet is very beneficial for disease prevention.

When diverticula begin to form, there are usually very few symptoms, except for occasional contractions in the left iliac fossa. As diverticular disease progresses, the lower colon may become less mobile, deformed, and narrowed. At that time, stools are usually thin and small, constipated, sometimes with episodes of diarrhea. When mechanical and structural problems arise, treatment becomes more difficult.

The complication rate of diverticular disease is relatively low. However, serious complications can still occur. Diverticulitis is the most common complication.

Like a balloon, the diverticulum expands, and the wall becomes thinner compared to the rest of the colon. The colon is home to many beneficial bacteria while they are still in the colon. However, these bacteria can penetrate the thin wall of the diverticulum and cause an infection, a condition called diverticulitis. Mild inflammation causes only mild pain in the left iliac fossa. If the inflammation is severe, it will cause a lot of pain and fever.
Diverticulitis needs to be treated. You will need antibiotics and fasting, sometimes even drinking, to give the colon a rest. In severe cases, the patient needs to be hospitalized.

Hemorrhagic complications occur due to rupture of a blood vessel in the colonic diverticulum. Fresh blood profusely from the anus or sometimes dark, mahogany stools, when bleeding occurs in the right colonic diverticulum.

This complication is rare, but it is the most serious complication. Bacteria from the colon escape into the abdomen causing peritonitis or abscess. In most cases, abdominal surgery is required to solve the problem.

There are several grades for diverticulitis of the colon. The two commonly used grades are the European laparoscopic surgery (European Association) for laparoscopic surgery and the Hinchey's grade for ruptured diverticulitis.
Table 1. The classification of EATs of the European Union of Laparographies

To assess the severity of ruptured diverticulitis, Hinchey gave a four-degree grading scale. Hinchey grade can be evaluated before or during surgery, preoperative assessment is mainly based on imaging. The Hinchey grade, modified by Wexner in 1997, separates grade II (pelvic abscess) into two more specific grades, IIa and IIb.
Table 2: Modified Hinchey grading for broken UC

(Source: Welch J.P. and Cohen J.L. (2006), "Diverticulitis", ACS Surgery: Principles and Practice, WebMD Professional Pub. , Ch.12, p.540-553)

The Hinchey grading is useful for treatment selection and prognosis. Most patients with grade I can be treated medically; 70-90% of patients with grades I or IIa can successfully drain; The mortality rate in patients with grades III is 6% and IV is 35%.

Once a diverticulum is formed it is permanent, there is no treatment to prevent diverticulitis complications. A high-fiber diet that increases stool volume and prevents constipation can help relieve symptoms.
There is no evidence for the ability of nuts to cause diverticulitis, however, if some patients develop signs of diverticulitis after eating nuts, they should not continue to eat but should be replaced with food. contain a lot of fiber such as fruits, vegetables, whole grains, legumes.
The American Dietetic Association recommends that women eat about 25 grams of fiber and men about 38 grams of fiber per day. Besides, drinking lots of water and exercising regularly are also effective.
Conclusion Colonic diverticulum is a common disease and is not dangerous unless there are complications. Although there is no way to prevent and treat the disease, it is possible to limit the formation of diverticula and its complications by eating a lot of fiber, drinking plenty of water, and exercising regularly. The grading of diverticulitis helps to confirm the diagnosis, guide treatment, and prognosis.
Currently, Vinmec International General Hospital is one of the leading hospitals in Vietnam that has been equipped with the most modern gastrointestinal endoscopy equipment of Olympus with the endoscopic method with narrow light frequency band (NBI). ) . This is a breakthrough method in screening and diagnosing cancers of the gastrointestinal tract (esophagus, stomach, duodenum and colon and rectum) at early and very early stages. NBI endoscopic images have high resolution and contrast, making it easy for doctors to detect small changes in color, morphology of cancerous and precancerous lesions that are difficult to detect with conventional endoscopy. .

References:
Le Huy Luu, Nguyen Van Hai (2010), "Results of right colonic diverticulum surgery by laparoscopic surgery", Medicine of Ho Chi Minh City, volume 14 (additional to No. 4). ), p.12-15. Ly Minh Tung, Nguyen Van Hai (2011), Clinical features, images, and surgical results for diverticulitis. Aldoori W.H., Giovannucci E.L., Rockett H.R., et al. (1998), "A prospective study of dietary fiber types and symptomatic diverticular disease in men", J Nutr, Vol.128 (4), p.714-719. Ambrosetti P., Robert J.H., Witzig J.A., et al. (1994), "Acute left colonic diverticulitis: a prospective analysis of 226 consecutive cases", Surgery, Vol.115 (5), p.546-550.