Diverticulitis classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]

Overview

Diverticular diseases may be classified based on the presenting signs and symptoms according to the German guidelines that were published by the German Society of Gastroenterology (DGVS) and of Visceral Surgery (DGAV) in 2014. This aggreed upon classification system (Classification of Diverticular Disease (CDD), takes signs and symptoms, natural history (symptomatic, asymptomatic, complicated, uncomplicated, acute, recurrent), surgical aspects (purulent vs. fecal peritonitis), and clinically relevant diagnostic tests into account. As a result, this classification comprises the entire spectrum of diverticular disease.

Classification

The following table describes the classification of diverticular disease according to the German guidelines (in 2014) by the German Societies of Gastroenterology (DGVS) and of Visceral Surgery (DGAV).

Type	Subtype	Description	Features
Type 0 (Asymptomatic diverticulosis)	Type 0	None	Incidental finding Asymptomatic; not a disease per se
Type 1 (Acute uncomplicated diverticulitis)	Type 1a	Diverticulitis without peridiverticulitis	Symptoms attributable to diverticula Signs of inflammation present Typical cross-sectional imaging
	Type 1b	Diverticulitis with phlegmonous peridiverticulitis	Signs of inflammation on laboratory tests Cross-sectional imaging demonstrates phlegmonous diverticulitis
Type 2 (Acute complicated diverticulitis)	Type 2a	Microabscess	Concealed perforation Small abscess (≤1 cm) Minimal paracolic air
	Type 2b	Macro-abscess	Paracolic or mesocolic abscess (>1 cm)
	Type 2c	Free perforation	Free perforation, free air/fluid Generalized peritonitis
	Type 2c1	Purulent peritonitis
	Type 2c2	Fecal peritonitis
Type 3 Chronic diverticular disease (relapsing or persistent)	Type 3a	Symptomatic uncomplicated diverticular disease (SUDD)	Localized symptoms Laboratory test (calprotectin)
	Type 3b	Relapsing diverticulitis without complications	Signs of inflammation present Cross-sectional imaging indicates inflammation
	Type 3c	Relapsing diverticulitis with complications	Identification of stenosis, fistulas, conglomerate tumor
Type 4 (Diverticular bleeding)	Type 4	Diverticular bleeding	Diverticula identified as the source of bleeding