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 according to the German guidelines that were passed by the German Society of Gastroenterology (DGVS) and of Visceral Surgery (DGAV) in 2014. They unanimously agreed on a classification system (Classification of Diverticular Disease (CDD)), that takes practical algorithms (symptomatic, asymptomatic, complicated, uncomplicated, acute, recurrent), ongoing surgical aspects (purulent vs. fecal peritonitis), and contemporary diagnostic standards in clinical practice into account. As a result, this classification comprises the entire spectrum of diverticular disease.

Classification

The diverticular disease may be classified according to the German guidelines that were recently passed (in 2014) by the German Societies of Gastroenterology (DGVS) and of Visceral Surgery (DGAV). They classified it into symptomatic, asymptomatic, complicated, uncomplicated, acute, and recurrent.

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	Macroabscess	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