A B C 1 2 3 4 Uncomplicated disease Pain in left lower quadrant Fever Changes in relief pattern Chronic complicated disease Impaired passage of stool Presence of fistula Recurrent rectal blood loss Incapacitating complaints High-risk patients Acute complicated disease Fever Painful mass Ileus Massive rectal blood loss Generalized peritonitis CT scan or US Phlegmon Small abscess in bowel wall Colonoscopy Diverticulosis Inflammation CT scan Stenosis Fistula Colonoscopy Stenosis Fistula Blood in diverticula CT scan Large abscesses (>5 cm) CT scan Intestinal obstruction CT angio Contrast blush Colonoscopy Active diverticular bleeding CT scan Pneumoperitoneum Extraluminal contrast Free fluid Int J Colorectal Dis (2012) 27:207–214 Treatment Conservative treatment Treatment acute episode Antibioticsa Low residue dieta Prevention Fibers Prevention of obesity Treatment of comorbidity Mesalazinea Elective intervention Sigmoid resection with primary anastomosis Open Laparoscopically Acute intervention Percutaneous drainage Sigmoid resection with primary anastomosis Hartmann’s procedure Sigmoid resection with primary anastomosis Open Laparoscopically Endoscopic interventiona Endovascular coilinga Diagnostic laparotomy/laparoscopy Resection with primary anastomosis Hartmann’s procedure Lavage and drainagea 212 Table 6 Proposed classification Classification Clinical presentation Imaging aExperimental or non-evidence- based treatment between “symptomatic uncomplicated disease” and “recurrent symptomatic disease”. Furthermore, the category of “compli- cated disease” found in both Köhler and Hansen/Stock classifications embraces all possible complications of divertic- ular disease, both moderate and severe, and so may be confusing. In this classification, complications are certified by severity and therapeutic options. The original Hinchey classification for perforated diver- ticulitis and its modifications are mainly represented in stage C. Large abscesses (C1) and perforated disease (C4) are severe complications, but also massive diverticular (C3) bleeding and total bowel obstruction (C2) are entitled to acute interventions. In large abscesses, if amendable and usually larger than 5 cm, CT- or US-guided percutaneous drainage should be attempted as final treatment or bridge to surgery. Massive diverticular bleeding might be approached endoscopically (clipping, coagulation, or adrenaline injections) or even endovascular (coiling), but in most centers, a