Review of current classifications for diverticular disease and a translation into clinical practice

Abstract

Introduction: Diverticular disease of the sigmoid colon prevails in Western society. Its presentation may vary greatly per individual patient, from symptomatic diverticulosis to perforated diverticulitis. Since publication of the original Hinchey classification, several modifications and new grading systems have been developed. Yet, new insights in the natural history of the disease, the emergence of the computed tomography scan, and new treatment modalities plead for evolving classifications.

Methods: This article reviews all current classifications for diverticular disease.

Result: A three-stage model is advanced for a renewed and comprehensive classification system for diverticular disease, incorporating up-to-date imaging and treatment modalities.

Fig. 1

Hughes classification (Hughes et al. [4], reproduced with permission)

Fig. 2

CT scan images resembling the four Hughes stages. I Pericolic phlegmon with small associated abscess. II Large intraabdominal abscess. III Small amounts of free air and fluid. IV Massive pneumoperitoneum and free fluid