A patient with perforated sigmoid diverticulitis undergoes laparotomy. The surgeon finds generalized purulent peritonitis but no fecal contamination and no localized abscess. According to the Hinchey classification, this corresponds to which stage?

• A Hinchey I
• B Hinchey II
• C Hinchey IV
• D Hinchey III ✓

Explanation

Hinchey III is generalized purulent peritonitis from a perforated diverticulum without fecal contamination. Hinchey I is a pericolic abscess, Hinchey II is a contained pelvic or distant abscess, and Hinchey IV is generalized peritonitis with frank fecal contamination. The absence of feculent material in the peritoneum is the single finding that separates stage III from stage IV.

Reference: Sabiston Textbook of Surgery, 21st ed.

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