Diverticulitis classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2] James Nasr [3]

Overview

Diverticular diseases may be classified based on the presenting signs and symptoms according to the German guidelines that were published by the German Society of Gastroenterology (DGVS) and of Visceral Surgery (DGAV) in 2014. This aggreed upon classification system (Classification of Diverticular Disease (CDD), takes signs and symptoms, natural history (symptomatic, asymptomatic, complicated, uncomplicated, acute, recurrent), surgical aspects (purulent vs. fecal peritonitis), and clinically relevant diagnostic tests into account. As a result, this classification comprises the entire spectrum of diverticular disease. While the CDD system remains in use in some European centers, current U.S. guidance, including the 2025 JAMA review, primarily classifies diverticulitis as uncomplicated or complicated, with severity stratified using the modified Hinchey classification.^[1]

Classification

The following table describes the classification of diverticular disease according to the German guidelines (in 2014) by the German Societies of Gastroenterology (DGVS) and of Visceral Surgery (DGAV).^[2]

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 1 (Acute uncomplicated diverticulitis)	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	Macro-abscess	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

References

↑ Peery AF, Wilson GC, Crockett SD. Diverticulitis: A Review. JAMA. 2025;333(2):158-168. doi:10.1001/jama.2024.23427.
↑ Lembcke, Bernhard (2015). “Diagnosis, Differential Diagnoses, and Classification of Diverticular Disease”. Viszeralmedizin. 31 (2): 95–102. doi:10.1159/000380833. ISSN 1662-6664.

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[1] Peery AF, Wilson GC, Crockett SD. Diverticulitis: A Review. JAMA. 2025;333(2):158-168. doi:10.1001/jama.2024.23427.

[Lembcke2015-2] Lembcke, Bernhard (2015). “Diagnosis, Differential Diagnoses, and Classification of Diverticular Disease”. Viszeralmedizin. 31 (2): 95–102. doi:10.1159/000380833. ISSN 1662-6664.

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Diverticulitis classification

Overview

Classification

References

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