From the Guidelines
Hinchey diverticulitis is a classification system used to categorize the severity of complicated diverticulitis based on the degree of peritoneal contamination, consisting of four stages that guide treatment decisions and predict outcomes. The Hinchey classification system is crucial in determining the appropriate level of intervention needed for patients with diverticulitis, with higher stages generally having worse prognoses and requiring more aggressive treatment approaches 1. The four stages of Hinchey diverticulitis are:
- Stage I: confined pericolic or mesenteric abscess
- Stage II: pelvic, intra-abdominal, or retroperitoneal abscess
- Stage III: generalized purulent peritonitis from a perforated diverticulum
- Stage IV: fecal peritonitis resulting from free communication between the bowel lumen and peritoneal cavity Understanding a patient's Hinchey stage allows clinicians to develop appropriate treatment plans and communicate effectively about disease severity, with Stages I and II often managed with antibiotics and possibly percutaneous drainage, while Stages III and IV typically require emergency surgery 1. Some key points to consider when managing Hinchey diverticulitis include:
- The use of Hartmann's procedure (HP) versus primary anastomosis with or without diverting stoma, with HP being recommended for critically ill patients and primary anastomosis being suggested for clinically stable patients with no comorbidities 1
- The importance of considering the patient's clinical condition and comorbidities when deciding on the surgical approach 1
- The potential benefits of primary anastomosis with diverting ileostomy over HP in patients with diverticular peritonitis, including reduced length of stay, lower costs, and greater stoma reversal rates 1.
From the Research
Definition of Hinchey Diverticulitis
- Hinchey diverticulitis refers to a classification system used to describe the severity of diverticulitis, which is a condition characterized by inflammation of the diverticula in the colon 2.
- The Hinchey classification system categorizes diverticulitis into four stages:
- Stage I: Diverticulitis with phlegmon
- Stage II: Diverticulitis with abscess
- Stage III: Diverticulitis with purulent peritonitis
- Stage IV: Diverticulitis with fecal peritonitis
Treatment of Hinchey Diverticulitis
- The treatment of Hinchey diverticulitis depends on the stage and severity of the condition 2, 3.
- For Stage I and II diverticulitis, treatment may involve antibiotics and/or percutaneous drainage of the abscess.
- For Stage III and IV diverticulitis, treatment may involve surgical intervention, such as laparoscopic lavage or colonic resection.
- Laparoscopic lavage has been shown to be a safe and effective treatment option for patients with Hinchey III-IV diverticulitis, with shorter operative times and hospital stays compared to colonic resection 3.
Comparison with Other Classification Systems
- The Hinchey classification system has been compared to other classification systems, such as the American Association for the Surgery of Trauma (AAST) grading scale 4.
- The AAST grading scale has been shown to be equivalent to the Hinchey classification system in predicting outcomes, such as the need for procedural intervention and complications.
- However, the AAST grading scale may be preferable to the Hinchey classification system because it can be applied preoperatively 4.
Management and Prevention
- The management of diverticulitis involves a combination of medical and surgical treatments, as well as lifestyle modifications to prevent recurrences 5, 6.
- Increased intake of dietary fiber, exercise, cessation of smoking, and weight loss may help to prevent recurrences of diverticulitis.
- Colonoscopy is recommended four to six weeks after resolution of symptoms for patients with complicated disease or for another indication, such as age-appropriate screening 6.