A 58-year-old man with acute diverticulitis has free purulent fluid in the peritoneal cavity on CT but no faecal contamination. According to the Hinchey classification, what stage is this?
- A Hinchey I
- B Hinchey II
- C Hinchey III ✓
- D Hinchey IV
Correct answer: C. Hinchey III
Explanation
The Hinchey classification stages complicated diverticulitis: stage I is pericolic abscess, stage II is pelvic or distant abscess, stage III is generalised purulent peritonitis, and stage IV is generalised faecal peritonitis. Purulent peritonitis without faecal contamination therefore defines Hinchey III. This distinction matters because lavage-based approaches are considered only for purulent contamination, while faecal peritonitis mandates resection with washout, typically Hartmann's procedure.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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