A 60-year-old man undergoes CT for severe generalised abdominal pain. He has known sigmoid diverticular disease. The scan shows free extraluminal gas with localised pericolic abscess measuring 5 cm. According to the modified Hinchey classification, this is:
- A Stage I
- B Stage II ✓
- C Stage III
- D Stage IV
Correct answer: B. Stage II
Explanation
Hinchey II is a contained pelvic or distant abscess complicating diverticulitis, whether walled off by omentum or mesentery. Stage I is confined pericolic inflammation or small pericolic abscess, Stage III is generalised purulent peritonitis without gross faecal contamination, and Stage IV is faeculent peritonitis. Free gas with a discrete drainable abscess places the patient in Stage II, which may be managed with antibiotics plus image-guided drainage rather than immediate surgery.
Reference: Bailey and Love Short Practice of Surgery, 27th ed.
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