Classification and Management of Acute Diverticulitis

Classification Systems

The Hinchey classification is the most widely used system for categorizing the severity of acute colonic diverticulitis, consisting of four stages that guide treatment decisions based on the extent of infection and inflammation beyond the colon 1
The original Hinchey classification categorizes diverticulitis into four progressive stages, including pericolic abscess, pelvic or intra-abdominal abscess, generalized purulent peritonitis, and fecal peritonitis 2, 1
The Modified Hinchey Classification incorporates CT findings for more precise diagnosis, including stages for mild clinical diverticulitis, confined pericolic inflammation, and generalized purulent peritonitis 2, 3
The Mora Lopez Classification divides Neff stage 1 into localized pneumoperitoneum, abscess < 4 cm, and complicated diverticulitis with pelvic abscess (> 4 cm in pelvis) 2, 4
The Sallinen Classification is based on clinical, radiologic, and physiologic parameters, including stages for uncomplicated diverticulitis, complicated diverticulitis with small abscess, and generalized peritonitis with organ dysfunction 2, 3
The WSES CT-Guided Classification divides acute diverticulitis into uncomplicated and complicated forms, including stages for diverticula, pericolic air bubbles, and diffuse fluid with distant free gas 2, 4

CT imaging is essential for accurate classification and management planning of diverticulitis 1
Non-operative management with bowel rest and antibiotics is recommended for Hinchey 1b (small abscess < 4 cm) 1
Percutaneous drainage is recommended for Hinchey 2 (larger abscess > 4 cm) 1