What is the clinical staging of diverticulitis using the Hinchey and modified Hinchey classifications?

Updated: Aug 06, 2019
  • Author: Elie M Ghoulam, MD, MS; Chief Editor: BS Anand, MD  more...
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Answer

Clinical staging by Hinchey's classification is based on computed tomography findings and directed toward selection of the proper surgical procedure when diverticulitis is complicated, as follows:

  • Stage I disease: Phlegmon or localized pericolic or mesenteric abscess

  • Stage II disease: Walled-off pelvic, intra-abdominal, or retroperitoneal abscess

  • Stage III disease: Perforated diverticulitis causing generalized purulent peritonitis

  • Stage IV disease: Rupture of diverticula into the peritoneal cavity, with fecal contamination causing generalized fecal peritonitis

Table. Modified Hinchey Classification Stage and Diverticulitis Category (Open Table in a new window)

Modified Hinchey Classification Stage

Category

0

Clinically mild diverticulitis, or diverticula with colonic wall thickening on CT

Uncomplicated

Ia

Colonic reaction with inflammatory reaction in the pericolic fat (phlegmon)

Uncomplicated

Ib

Pericolic or mesenteric abscess

Complicated

II

Intra-abdominal abscess, pelvic or retroperitoneal abscess

Complicated

III

Generalized purulent peritonitis

Complicated

IV

Generalized fecal peritonitis

Complicated


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