In the Hinchey classification of complicated acute diverticulitis used to guide operative strategy, what defines Hinchey stage II?
- A Pericolic abscess confined by the mesocolon
- B Generalized purulent peritonitis
- C Pelvic abscess distant from the inflamed sigmoid segment ✓
- D Feculent peritonitis
Correct answer: C. Pelvic abscess distant from the inflamed sigmoid segment
Explanation
The Hinchey classification grades perforated diverticulitis: stage I is a pericolic or mesocolic abscess, stage II is a walled-off pelvic or distant intra-abdominal abscess, stage III is generalized purulent peritonitis, and stage IV is feculent peritonitis. Stage III and IV require laparotomy with resection and lavage, while selected stage I and II collections can be managed with antibiotics and image-guided drainage. Feculent contamination represents free perforation with gross spillage and carries the highest mortality.
Reference: Schwartz's Principles of Surgery, 11th ed.
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