Question:
A patient presents with faecal peritonitis, and at laparotomy a perforated diverticulum is found with frank faecal contamination of the peritoneal cavity. According to the Hinchey classification, this corresponds to which stage?
A patient presents with faecal peritonitis, and at laparotomy a perforated diverticulum is found with frank faecal contamination of the peritoneal cavity. According to the Hinchey classification, this corresponds to which stage?
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Faecal contamination is the worst, so it must be the highest grade.
Updated On: Jun 23, 2026
- Stage I
- Stage II
- Stage III
- Stage IV
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The Correct Option is D
Solution and Explanation
Correct option: Stage IV.
Step 1: The Hinchey classification grades complicated diverticulitis by the extent and nature of the peritoneal contamination.
Step 2: The four stages are: I, mesenteric or pericolic abscess; II, pelvic (walled-off) abscess; III, generalised purulent peritonitis; IV, generalised faecal peritonitis.
Step 3: This patient has frank faecal peritonitis, which is the most severe grade, so it is Hinchey stage IV. This carries the highest mortality and usually mandates a Hartmann procedure.
Why not stage III: Stage III is purulent (pus) peritonitis without free faecal soiling; the presence of faeces upgrades it to stage IV.
Ref: Bailey and Love, Short Practice of Surgery, 27th edition, 2018.
Step 1: The Hinchey classification grades complicated diverticulitis by the extent and nature of the peritoneal contamination.
Step 2: The four stages are: I, mesenteric or pericolic abscess; II, pelvic (walled-off) abscess; III, generalised purulent peritonitis; IV, generalised faecal peritonitis.
Step 3: This patient has frank faecal peritonitis, which is the most severe grade, so it is Hinchey stage IV. This carries the highest mortality and usually mandates a Hartmann procedure.
Why not stage III: Stage III is purulent (pus) peritonitis without free faecal soiling; the presence of faeces upgrades it to stage IV.
Ref: Bailey and Love, Short Practice of Surgery, 27th edition, 2018.
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