🔥 Hinchey Classification Diverticulitis Staging Simulator

Stage Ia — Confined Pericolic Phlegmon or Microabscess

A tiny abscess stays walled off right next to the inflamed colon.

• Pericolic: Location (Adjacent to colon wall)
• <2 cm: Size (Typically small)
• Confined: Containment (No free spread)
• Antibiotics: First-line (Outpatient possible)

What defines Stage Ia

Localized inflammation with a small confined pericolic abscess.

Typical presentation

Mild left lower quadrant pain, low-grade fever, minimal peritoneal signs.

Stage Ib/II — Larger Walled-Off Pelvic or Distant Abscess

A bigger abscess forms further away but stays contained by adhesions.

• Pelvic/distant: Location (Beyond pericolic space)
• ≥4 cm: Size (Often drainable)
• Walled off: Containment (Adhesion-bound)
• Drain + antibiotics: First-line (CT-guided)

What defines Stage Ib/II

A larger collection separate from the colon, still contained.

Management shift

Percutaneous drainage often avoids emergency surgery.

Stage III — Generalized Purulent Peritonitis

The abscess ruptures and pus spreads through the abdominal cavity.

• Diffuse: Spread (Free purulent fluid)
• Open: Perforation (No fecal contamination)
• Generalized: Peritonitis (Rebound tenderness)
• Surgery: First-line (Lavage or resection)

What defines Stage III

Pus, not stool, spreads freely through the peritoneal cavity.

Surgical options

Laparoscopic lavage or resection depending on stability.

Stage IV — Generalized Feculent Peritonitis

Free perforation spills stool into the abdomen, the most severe stage.

• Diffuse: Spread (Fecal contamination)
• Free: Perforation (Direct colon opening)
• Highest: Mortality (Among the four stages)
• Emergency surgery: First-line (Hartmann procedure)

What defines Stage IV

Free fecal spillage causes the most severe contamination.

Emergency management

Resection with diversion; primary anastomosis is high risk.

Stage IV carries the highest mortality of all Hinchey stages.

Treatment Tactic Escalation Across Hinchey Stages

Management escalates from antibiotics alone to emergency resection.

• Antibiotics: Stage I (± outpatient care)
• Drain + antibiotics: Stage II (CT-guided percutaneous)
• Lavage/resection: Stage III (Laparoscopic or open)
• Hartmann: Stage IV (Resection + diversion)

Choosing the right tactic

Stage, stability, and drainable collections guide the decision.

Escalation principle

Less invasive options are tried first when safely possible.