Hinchey classification is used to stage perforated diverticulitis. A patient presents with faecal peritonitis and CT confirms free faecal contamination of the peritoneal cavity with no abscess. What Hinchey stage is this and what is the standard surgical treatment?

• A Hinchey Stage II; laparoscopic washout and drainage
• B Hinchey Stage IV; Hartmann's procedure ✓
• C Hinchey Stage III; Hartmann's procedure
• D Hinchey Stage IV; primary anastomosis with defunctioning ileostomy

Explanation

Free faecal peritonitis is Hinchey Stage IV (Stage III = purulent peritonitis without faeces). Stage IV carries the highest mortality and traditionally mandates Hartmann's procedure (sigmoid resection, end colostomy, closure of rectal stump). Primary anastomosis with defunctioning ileostomy may be considered in selected, haemodynamically stable patients at specialist centres, but Hartmann's remains the most widely practised option. Hinchey I = pericolic abscess, II = pelvic/retroperitoneal abscess.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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