Application of a modified Neff classification to patients with uncomplicated diverticulitis

Colorectal Dis. 2013 Nov;15(11):1442-7. doi: 10.1111/codi.12449.


Aim: Severity of acute diverticulitis (AD) has traditionally been assessed using the Hinchey classification; however, this classification is predominantly a surgical one. The Neff classification provides an alternative classification based on CT findings. The aim of this study was to evaluate a modification of the Neff classification to select patients presenting with early-stage AD to receive outpatient management.

Method: All patients with AD, presenting to a single unit, were prospectively studied. All patients underwent emergency abdominal CT and were assigned a Neff stage, including a modification (mNeff) to Neff Stage I. The Neff stages used were: Stage 0, uncomplicated diverticulitis; Diverticula, thickening of the wall, increased density of the pericolic fat; Stage I, locally complicated (our modification included substages Ia (localized pneumoperitoneum in the form of air bubbles) and Ib (local abscess); Stage II, complicated with pelvic abscess; Stage III, complicated with distant abscess; and Stage IV, complicated with other distant complications. Patients who presented with Stage 0 or Stage Ia were selectively managed as outpatients. Patients with comorbidity or the presence of the systemic inflammatory response syndrome (SIRS) were excluded.

Results: Between February 2010 and January 2013, 205 patients (mean age 59 years; age range 25-90 years) presented with AD. One-hundred and forty-nine met the radiological criteria for potential outpatient treatment. After applying the exclusion criteria, 68 were eventually assigned to an outpatient programme. Sixty-four (94%) successfully completed the outpatient treatment protocol; four patients were readmitted.

Conclusion: Our mNeff classification allowed selected patients with AD to be successfully managed in an outpatient programme.

Keywords: Acute diverticulitis; Neff's classification; outpatient.

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Aged, 80 and over
  • Ambulatory Care*
  • Anti-Bacterial Agents / therapeutic use
  • Diverticulitis / classification*
  • Diverticulitis / diagnostic imaging*
  • Diverticulitis / therapy
  • Female
  • Hospitalization*
  • Humans
  • Male
  • Middle Aged
  • Patient Selection*
  • Tomography, X-Ray Computed


  • Anti-Bacterial Agents