CT scan of a 62-year-old man with perforated sigmoid diverticulitis demonstrates free intraperitoneal gas and frank faecal contamination distributed throughout the peritoneal cavity. According to the Hinchey classification, this corresponds to which stage?
- A Hinchey Ia
- B Hinchey II
- C Hinchey IV ✓
- D Hinchey III
Correct answer: C. Hinchey IV
Explanation
The Hinchey classification stages perforated diverticulitis as follows: Ia is a pericolic abscess, Ib a pelvic abscess, II generalised purulent peritonitis, III localised faecal peritonitis, and IV generalised faecal peritonitis. Faecal contamination spread diffusely through the abdomen defines Hinchey IV, the highest stage. The tempting distractor, Hinchey III, differs by having pus rather than faeces and being localised rather than diffuse, which changes operative strategy and prognosis.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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