From the Guidelines
Hinchey I (Hinchey 1, diverticulitis classification) refers to a pericolic abscess or phlegmonous diverticulitis, which is a stage of acute diverticulitis characterized by localized inflammation without any abscess or perforation.
Key Characteristics of Hinchey I Diverticulitis
- Pericolic abscess
- Phlegmonous diverticulitis
- Localized inflammation
- No abscess or perforation
Classification Systems for Acute Diverticulitis
There are multiple classification systems for acute diverticulitis, including the Hinchey classification, which has been widely used for the past three decades 1. The Hinchey classification divides the severity of acute diverticulitis into four levels:
- Hinchey I: pericolic abscess
- Hinchey II: pelvic, intra-abdominal, or retroperitoneal abscess
- Hinchey III: generalized purulent peritonitis
- Hinchey IV: fecal peritonitis at presentation
Modified Hinchey Classification
In 2005, Kaiser et al. modified the Hinchey classification according to specific CT findings, which includes:
- 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
Management of Hinchey I Diverticulitis
The management of Hinchey I diverticulitis typically involves antibiotic therapy, although recent studies have suggested that antibiotics may not be necessary in all cases of uncomplicated diverticulitis 1. The decision to use antibiotics should be based on the individual patient's clinical presentation and risk factors. Some key points to consider when managing Hinchey I diverticulitis include:
- Antibiotic therapy may not be necessary in all cases of uncomplicated diverticulitis
- The use of antibiotics should be based on the individual patient's clinical presentation and risk factors
- Recent studies have suggested that observational treatment without antibiotics may be appropriate in patients with uncomplicated diverticulitis 1
From the Research
Hinchey I Classification
- Hinchey I stage is a small (<4 cm) pericolic abscess 2
- This stage is treated with intravenous antibiotics 2
- The Hinchey classification is used to assess the severity of infectious complications in diverticulitis 2
Comparison with Other Classifications
- The modified Hinchey classification is the most commonly used classification for acute colonic diverticulitis 3
- The American Association for the Surgery of Trauma (AAST) grading scale is equivalent to the modified Hinchey classification in predicting procedural intervention and complications 4
- The AAST system may be preferable to Hinchey because it can be applied preoperatively 4
Diagnosis and Treatment
- Computed tomography (CT) scanning can be used to diagnose and stage diverticulitis, but its accuracy in predicting Hinchey's classification is not very high 5
- The combination of a large amount of free intra-abdominal air and fluid is a reliable indicator for required surgical treatment 5
- Simple diverticulitis is successfully managed with oral or intravenous antibiotics 2
- Recent studies recommend conservative management of uncomplicated forms of diverticulitis 6