Hinchey Classification

Hinchey Classification is used to describe perforations of the colon due to diverticulitis.

Diverticulosis (the presence of bowel diverticula) is an essentially ubiquitous phenomenon. With age, all people develop 'out-pouching' of the bowel wall as pressure from the inside of the bowel pushes the mucosa outwards. The pouches occur where there is a gap between the muscle fibres of the bowel wall. Inflammation of these diverticula (singular: diverticulum) is termed diverticulitis and occurs when the diveritcula become infected. This classically causes pain, bleeding and diarrhea. There are several complications that can arise from this inflammation and one of the more serious complications of this is perforation of the bowel.

If the perforation is very small, it may be contained (often referred to by surgeons as a localized perforation). However, if it is not contained it leads to faecal contamination of the peritoneal cavity (faecal peritonitis) which is often fatal.

The Hinchey classification - proposed by Hinchey et al. in 1978[1] classifies a colonic perforation due to diverticular disease. The classification is I-IV:

  • Hinchey I - localised abscess (para-colonic)
  • Hinchey II - pelvic abscess
  • Hinchey III - purulent peritonitis (the presence of pus in the abdominal cavity)
  • Hinchey IV - feculent peritonitis.

The Hinchey classification is useful as it guides surgeons as to how conservative they can be in emergency surgery. Recent studies have shown with anything up to a Hinchey III, a laparoscopic wash-out is a safe procedure,[2] avoiding the need for a laparotomy and stoma formation.


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