Int J Colorectal Dis (2012) 27:207–214 DOI 10.1007/s00384-011-1314-5 ORIGINAL ARTICLE Review of current classifications for diverticular disease and a translation into clinical practice Bastiaan R. Klarenbeek & Niels de Korte & Donald L. van der Peet & Miguel A. Cuesta Accepted: 30 August 2011 / Published online: 17 September 2011 # The Author(s) 2011. This article is published with open access at Springerlink.com 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. Keywords Diverticulitis . Diverticular disease . Classification Introduction Diverticular disease of the sigmoid colon is a common condition in Western society. Its presentation among patients may vary from symptomatic diverticulosis to perforated diverticulitis. The incidence for diverticulosis is 33–66%. Of these patients, 10–25% will develop an acute episode of diverticulitis [1]. Although diverticular disease is more common among elderly patients, a dramatic rise of its B. R. Klarenbeek (*) : N. de Korte : D. L. van der Peet : M. A. Cuesta Department of Surgery, VU University Medical Center, Postbus 7057, 1007 MB Amsterdam, The Netherlands e-mail: br.klarenbeek@vumc.nl incidence is seen in the younger age groups [2]. Further- more, depending on the severity of the disease, the treatments for the various presentations of the disease will differ. Accordingly, diagnostic tools, indications for surgery as well as treatment modalities have been evolving, resulting in more options in the therapy for diverticular disease. Since Hinchey’s traditional classification for perforated diverticulitis in 1978, several modifications and new grading systems have been presented to display a more contemporary overview of the disease [3]. Unfortunately, these different classifications of diverticular disease have led to conflicting terminology in current literature. More- over, none of the classifications seem to sufficiently embrace the entire spectrum of the disease. This calls for a thorough review and a new parameter. The current classifications of diverticular disease are based on clinical, radiological, or operative findings, yet most lack a translation into daily clinical practice. Given a useful classification system ought to guide clinical decision making and management, this review serves to combine the available classifications with current knowl- edge of practice into a more useful practice parameter for treating diverticular disease. Methods An extensive literature analysis was performed using the PubMed database. The following “MeSH” terms were used during the first PubMed search: diverticulitis, classification, and colonic diverticulosis. Only a few classifications for diverticular disease were revealed. In most publications, the results of a clinical study on imaging or treatment modalities are described, and rarely the proposal of a new classification