Diverticular Disease: Classification

There is no standard classification for diverticular disease/diverticulitis. In clinical practice, the classification according to Hansen and Stock is suitable

Stage Designation Symptomatology Colonoscopy/colonic contrast enema Abdominal CT
0 Diverticulosis – Irritable diverticula Diverticula gas-/KM (contrast medium)-filled
I Acute uncomplicated diverticulitis Lower abdominal pain Mucosal redness around diverticular necks/ spicules, bowel wall thickening + possibly bowel wall thickening
II Acute complicated diverticulitis
IIa Peridiverticulitis, phlegmonous diverticulitis Pressure pain or local defensive tension, palpable roller, fever Mucosal redness around diverticular neck/ spicules, bowel wall thickening + Density enhancement pericolic (around the intestine).
IIb Abscessing diverticulitis, covered perforation, fistula Local peritonism (localized peritonitis), fever, atony Mucosal redness around diverticular neck/ spicules, bowel wall thickening, possible KM extralumia + mesocolic (mesocolon: mesentery of the colon)/retroperitoneal (located behind the peritoneum) abscess (encapsulated collection of pus)
IIc Free perforation Acute abdomen Examination not indicated Free air/fluid, abscesses if any.
III Chronic recurrent diverticulitis Recurrent lower abdominal pain, possibly fever, possibly constipation or subileus (precursor to ileus/bowel obstruction), possibly urinary air leakage Stenosis, fistula Intestinal wall thickening, possibly stenosis (narrowing), fistula

Classification of diverticular disease/diverticulitis, Classification of diverticular disease (CDD).

Type 0 Asymptomatic diverticulosis
Incidental finding; asymptomatic No disease
Type 1 Acute uncomplicated diverticular disease/diverticulitis.
Type 1a
  • Diverticulitis/diverticular disease without environmental reaction.
 Symptoms related to diverticula Inflammatory signs (laboratory): optional Typical cross-sectional imaging.
Type 1b
  • Diverticulitis with phlegmonous bypass reaction.
 Signs of inflammation (laboratory): obligatory sectional imaging: phlegmonous diverticulitis.
type 2 Acute complicated diverticulitis as 1b, plus:
Type 2a
  • Microabscess (small encapsulated pus cavity).
 Covered perforation, small abscess (≤ 1 cm); minimal paracolic air.
Type 2b
  • Macroabscess (larger encapsulated pus cavity).
 Para- or mesocolic abscess (> 1 cm).
Type 2c
  • Free perforation (leakage of stool and air throughout the abdomen).
 Free perforation, free air / fluid generalized peritonitis.
Type 2c1
  • Purulent peritonitis (inflammation of the peritoneum)
Type 2c2
  • Fecal peritonitis
Type 3 Chronic diverticular disease Recurrent (recurrent) or persistent symptomatic diverticular disease.
Type 3a
  • Symptomatic uncomplicated diverticular disease (SUDD).
 Typical clinic inflammatory signs (laboratory): optional.
Type 3b
  • Recurrent diverticulitis without complications.
 Signs of inflammation (laboratory) present Cross-sectional imaging: typical.
type 3c
  • Recurrent diverticulitis with complications
 Evidence of stenosis, fistula, conglomerate.
Type 4 Diverticular hemorrhage Detection of the source of bleeding