Diverticulitis classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
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Overview
Classification
Diverticulitis may be classified according to the German guideline which was recently (2014) passed by the German Societies of Gastroenterology (DGVS) and of Visceral Surgery (DGAV). They unanimously agreed on another classification (Classification of Diverticular Disease (CDD)), which 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.[1]
| Type | Subtype | Features | |
|---|---|---|---|
| Type 0
Asymptomatic diverticulosis |
Type 0 |
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| Type 1
Acute uncomplicated diverticulitis |
Type 1a | diverticulitis without peridiverticulitis | symptoms attributable to diverticula; signs of inflammation (laboratory tests): optional; typical cross-sectional imaging |
| Type 1b | diverticulitis with phlegmonous peridiverticulitis | signs of inflammation (laboratory tests): mandatory; cross-sectional imaging: 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): optional |
| Type 3b | relapsing diverticulitis without complications | signs of inflammation (laboratory tests): present; cross-sectional imaging: indicates inflammation | |
| Type 3c | relapsing diverticulitis with complications | identification of stenoses, fistulas, conglomerate tumor | |
| Type 4
Diverticular bleeding |
Type 4 | diverticula identified as the source of bleeding | |
References
- ↑ DeJoy SQ, Ferguson KM, Sapp TM, Zabriskie JB, Oronsky AL, Kerwar SS (1989). "Streptococcal cell wall arthritis. Passive transfer of disease with a T cell line and crossreactivity of streptococcal cell wall antigens with Mycobacterium tuberculosis". J Exp Med. 170 (2): 369–82. PMC 2189401. PMID 2502600.