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Q1: Hinchey Classification (3 min)
"Describe the Hinchey classification for perforated diverticulitis."
- Stage I: pericolic abscess or paracolic inflammation
- Stage II: distant abscess (pelvic, intra-abdominal)
- Stage III: generalised purulent peritonitis
- Stage IV: generalised faecal peritonitis
- Management: I-II conservative/CT drainage; III surgery (PA + ileostomy or Hartmann's); IV Hartmann's
Q2: Management Algorithm (3 min)
"How do you manage acute diverticulitis?"
- Uncomplicated: oral antibiotics (co-amoxiclav), clear fluids, analgesia, outpatient
- Abscess over 3cm: IV antibiotics + CT-guided percutaneous drainage
- Perforation + peritonitis: emergency surgery (Hartmann's for Hinchey IV)
- Recurrent (2+ episodes): elective laparoscopic sigmoid resection
- Bleeding: resuscitation, colonoscopy/angiography, surgery if uncontrolled
Q3: Colovesical Fistula (2 min)
"How does a colovesical fistula present and how is it managed?"
- Pneumaturia (gas in urine), faecaluria, recurrent UTIs
- CT: connection between sigmoid and bladder dome
- Management: elective sigmoid resection + primary anastomosis
- Bladder defect usually small — can be left to heal or oversewn
- Defunctioning stoma rarely needed
Q4: Post-Attack Follow-up (2 min)
"What follow-up is needed after an episode of acute diverticulitis?"
- Colonoscopy at 6-8 weeks to exclude colorectal cancer
- NOT during acute episode (perforation risk through inflamed wall)
- High-fibre diet advice
- Consider elective resection after 2+ documented episodes
- Individualise based on age, severity, complications