From the Guidelines
Hinchey I diverticulitis is characterized by phlegmonous diverticulitis or a confined pericolic inflammation.
Classification Details
- The Hinchey classification is a widely used system to classify the severity of acute diverticulitis, which includes four stages:
- Stage 1: Phlegmonous diverticulitis or a confined pericolic inflammation (Hinchey I)
- Stage 2: Pelvic, intra-abdominal, or retroperitoneal abscess
- Stage 3: Generalized purulent peritonitis
- Stage 4: Fecal peritonitis at presentation
- A modified version of the Hinchey classification was proposed by Kaiser et al. in 2005, which includes the following stages:
- Stage 0: Mild clinical diverticulitis
- Stage 1a: Confined pericolic inflammation
- Stage 1b: Confined pericolic abscess
- Stage 2: Pelvic or distant intra-abdominal abscess
- Stage 3: Generalized purulent peritonitis
- Stage 4: Fecal peritonitis at presentation 1
- The DIABOLO trial, a randomized controlled trial, confirmed that observational treatment without antibiotics did not prolong recovery and could be considered appropriate in patients with Hinchey stages 1a and 1b diverticulitis 1
Clinical Relevance
- The classification of acute diverticulitis is crucial in determining the appropriate treatment course, with uncomplicated diverticulitis (Hinchey I) often managed conservatively, while complicated diverticulitis may require surgical intervention 1
- The use of antibiotics in uncomplicated diverticulitis is still a topic of debate, with some studies suggesting that antibiotics can be safely omitted in patients with a first episode of uncomplicated (Hinchey 1a) acute left-sided colonic diverticulitis 1
From the Research
Hinchey Classification
The Hinchey classification is a system used to categorize the severity of acute colonic diverticulitis 2. The modified Hinchey classification is the most commonly used and consists of four major categories (I, II, III, IV) and two additional subcategories (Ia and Ib) 2.
Hinchey I Classification
- Hinchey I refers to phlegmon or a confined diverticular perforation with no free fluid or only a small amount of fluid in the pelvis 3
- The classification is used to determine the best therapeutic approach and predict perioperative complications for patients who need surgery 2
- The Hinchey classification has been shown to be a useful guide for surgical decision making, but its accuracy in predicting outcomes can be improved [(4,5)]
- Preoperative staging of perforated diverticulitis by computed tomography scanning can help identify patients with Hinchey I classification, but its accuracy is not very high 3
Clinical Relevance
- The Hinchey classification is an important tool for clinicians to assess the severity of acute colonic diverticulitis and make informed decisions about treatment [(2,6)]
- Understanding the Hinchey classification is essential for emergency physicians, radiologists, and surgeons to improve patient care and management 2