A 55-year-old woman presents with left lower quadrant pain, fever, and leukocytosis. CT abdomen shows colonic diverticula with a 4 cm pericolic abscess. According to the modified Hinchey classification, what is the stage and appropriate management?

• A Hinchey stage I: intravenous antibiotics alone
• B Hinchey stage II: CT-guided percutaneous drainage and antibiotics
• C Hinchey stage Ib: CT-guided percutaneous drainage and antibiotics ✓
• D Hinchey stage III: emergency Hartmann's procedure

Explanation

Hinchey Ib is defined as a pericolic abscess greater than 3 cm. Management is CT-guided percutaneous drainage with antibiotics. Hinchey I is pericolic phlegmon without abscess. Hinchey II is a distant abscess (pelvic or retroperitoneal). Hinchey III is generalized purulent peritonitis and stage IV is feculent peritonitis, both requiring emergency surgery.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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