NMS. Casos Clínicos

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Part II ♦ Specific Disorders

Case 8.30 Recurrence of Left Lower Quadrant Pain

The patient described in Case 8.29 returns 6 months later with a recurrence of the same problem.

Q: How does this change the proposed management plan? A: In the past, aggressive, surgical resection would be recommended after a second episode of uncomplicated diverticulitis. New data show that nonoperative management may be more effective for recurrent uncomplicated diverticulitis. More aggressive surgical care is reserved for complicated diverticulitis. The Hinchey staging of diverticulitis is illustrated in Figure 8-34. Stage 1 Stage 2

Omentum

Large bowel

Large abscess extending into pelvis

Small or confined

pericolic or mesenteric abscess

Pelvic bone

Stage 3

Stage 4

Omentum Figure 8-34: Representative Hinchey staging of diverticulitis. Stage 0 (not depicted) is mild diverticulitis without abscess formation. Stage I disease consists of small pericolic or mesenteric abscesses, whereas stage II disease has abscesses that are either pelvic or distant intra-abdominal sites. Stage III consists of purulent peritonitis, while stage IV represents fecal peritonitis. (From Britt LD, Peitzman AB, Barie PS, Jurkovich GJ. Acute Care Surgery , 2nd ed. Wolters Kluwer Health; 2018, Fig. 45-14.) SAMPLE Gaseous release Liquid discharge Fecal discharge