Stadiums

Until today there is no uniform stage classification of diverticulitis. However, the classification according to Hansen and Stock is suitable for clinical routine. Here the findings of the clinical examination, the colonoscopy or the colon contrast enema and the computer tomography of the abdomen are used.

Thus, the classification serves as the basis for a stage-appropriate therapy.

Stage 0 refers to diverticulosis, i.e. a bulging of the wall, but without inflammation. Accordingly, this stage is asymptomatic.
Stage 1 describes an acute uncomplicated diverticulitis.
This stage is accompanied by pain in the lower abdomen and possibly fever. However, there is no risk of intestinal perforation and it can usually be treated on an outpatient basis.
Stage 2 is the acute complicated diverticulitis. This stage is further divided into types 2a, 2b and 2c.Stage 2a describes a peridiverticulitis.
This means the inflammation is limited to the diverticulum. Here there is a local pressure pain, a slight defensive tension in the area of the inflammation, fever and a palpable resistance. In stage 2b the diverticulum has developed into an abscess, fistula or covered perforation.

This means that the intestine is perforated at the affected site, but the inflammation has not yet spread to the abdomen. This stage is accompanied by fever, peritonism and intestinal atony. Stage 2c refers to the free perforation of the diverticulum.

The intestine is perforated and the intestinal contents are emptied into the free abdominal cavity. This stage is associated with the symptom of an acute abdomen and is a life-threatening situation that requires surgical treatment as soon as possible.
Stage 3 describes a chronic recurrent diverticulitis. This is accompanied by recurrent lower abdominal pain, constipation and a subileus.

Hansen Stock

The Hansen and Stock classification is used to divide diverticulitis into three clinical stages and provides the basis for stage-adapted therapy. This classification is based on the synopsis of the clinical examination, colonoscopy, CT examination of the abdomen and colon contrast enema examination. Stage 0: There is only diverticulosis (multiple wall protrusions in the colon wall) without signs of inflammation and no symptoms.

Stage 1: There is an acute, uncomplicated diverticulitis without the risk of perforation, which can lead to pain in the lower abdomen and possibly fever. Stage 2: There is an acute, complicated diverticulitis, which is divided into three subforms and carries the risk of perforation. Stage 2a: A phlegmonous diverticulitis or peridiverticulitis (co-infection of the immediate diverticulitis surroundings) is present, which leads to local pressure pain and local defensive tension in the form of a too palpable resistance in the lower abdomen with accompanying fever.

Stage 2b: This is an abscessed diverticulitis, often in a covered perforated state, which, as in stage 2a, leads to local defensive tension/pressure pain, fever and also to a loss of tone of the intestinal muscles (intestinal paralysis) in the affected section of the colon. Stage 2c: There is a free intestinal rupture. The symptoms are those of an acute abdomen with diffuse peritonitis. Stage 3: This is a chronic, recurrent diverticulitis, which can lead to recurrent lower abdominal pain and constipation symptoms, which may end in a preliminary stage of intestinal obstruction.