A 58-year-old woman with acute diverticulitis has a contrast-enhanced CT showing a 5 cm well-defined collection in the pelvis adjacent to the inflamed sigmoid loop, with no free air or free fluid. There is no generalised peritonitis. Which Hinchey stage does this represent?

• A Stage I
• B Stage IV
• C Stage III
• D Stage IIb ✓

Explanation

The Hinchey classification stages perforated diverticulitis: stage I is a pericolic abscess, stage IIa a distant contained abscess such as mesenteric or omental, stage IIb a pelvic abscess, stage III generalised purulent peritonitis and stage IV faecal peritonitis. A contained pelvic collection defines Hinchey IIb. Stage III requires generalised purulent peritonitis, which this localised picture lacks, and that distinction kills the most tempting distractor.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.