The Hinchey staging system has been used to describe the severity of complicated diverticulitis. Stage 1 is colonic inflammation with presence of associated pericolic abscess. Stage 2 is colonic inflammation with a retroperitoneal or pelvic abscess. Stage 3 is colonic inflammation with purulent peritonitis. Stage 4 is colonic inflammation with fecal peritonitis.
Hinchey staging system 3 and 4 disease require immediate laparotomy. Patients with contained abscesses as in Stage 1 and 2 usually have percutaneous drainage with antibiotics with strong consideration given to elective colectomy as the more severe the first case, the greater the likelihood of recurrent events.
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