Hinchey classification of acute diverticulitis

Last revised by Arlene Campos on 10 Jun 2024

The Hinchey classification of acute diverticulitis can be applied to diverticulitis occurring anywhere in the bowel, not just in the colon ref.

The Hinchey classification is the most commonly used system (c.2020) 8 and has been variously modified since its original description 3,5,6; no single system has been shown to be superior in terms of patient outcomes 8. Most classifications do not address some aspects of diverticular disease, such as fistula formation or bowel obstruction ref.

In general, abscesses in stage Ib and II may be drained by interventional radiology, and stage III and IV disease is managed with emergent surgery ref.

  • stage 0:

    • clinical: mild clinical diverticulitis

    • CT finding: diverticula with colonic wall thickening

  • stage Ia: 

    • clinical: confined pericolic inflammation or phlegmon

    • CT finding: pericolic soft tissue changes

  • stage Ib: 

    • clinical: pericolic or mesocolic abscess

    • CT finding: Ia changes and pericolic or mesocolic abscess

  • stage II: 

    • clinical: pelvic, distant intra-abdominal or retroperitoneal abscess

    • CT finding: Ia changes and distant abscess, usually deep pelvic

  • stage III: 

    • clinical: generalized purulent peritonitis

    • CT finding: localized or generalized ascites, pneumoperitoneum, peritoneal thickening

  • stage IV: 

    • clinical: generalized fecal peritonitis

    • CT finding: same as stage III

The original surgical Hinchey classification was developed in 1978, by E John Hinchey et al. 3, categorizing four stages of acute diverticulitis 7. In the 1980s, with the introduction of CT, some modifications were made to the original surgical classification system as a radiological staging system was required for the management of acute diverticulitis, leading to the most recent modification made by Kaiser et al 6  in 2005. 

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