Question:medium
A patient presents with faecal peritonitis, and at laparotomy a perforated diverticulum is found with frank faecal contamination of the peritoneal cavity. According to the Hinchey classification, this corresponds to which stage?
A patient presents with faecal peritonitis, and at laparotomy a perforated diverticulum is found with frank faecal contamination of the peritoneal cavity. According to the Hinchey classification, this corresponds to which stage?
Show Hint
Faecal contamination is the worst, so it must be the highest grade.
Updated On: Jun 23, 2026
- Stage I
- Stage II
- Stage III
- Stage IV
Show Solution
The Correct Option is D
Solution and Explanation
Ladder of severity. Picture the Hinchey grades climbing from a contained collection to free soiling:
I = pericolic or mesenteric abscess (local).
II = pelvic abscess (still walled off, deeper).
III = purulent peritonitis (pus is now free in the abdomen).
IV = faecal peritonitis (stool is free in the abdomen, the worst).
Match the case: frank faeces in the peritoneal cavity sits at the very top of this ladder, so it is grade IV. The key discriminator from grade III is pus versus stool, and once faeces are free the grade is IV. This stage carries the highest mortality and typically needs a Hartmann resection with end colostomy. Hence stage IV is correct. Ref: Bailey and Love, Short Practice of Surgery, 27th edition, 2018.
I = pericolic or mesenteric abscess (local).
II = pelvic abscess (still walled off, deeper).
III = purulent peritonitis (pus is now free in the abdomen).
IV = faecal peritonitis (stool is free in the abdomen, the worst).
Match the case: frank faeces in the peritoneal cavity sits at the very top of this ladder, so it is grade IV. The key discriminator from grade III is pus versus stool, and once faeces are free the grade is IV. This stage carries the highest mortality and typically needs a Hartmann resection with end colostomy. Hence stage IV is correct. Ref: Bailey and Love, Short Practice of Surgery, 27th edition, 2018.
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