Hughes et al identified clinical stages associated with perforated diverticular disease.
Clinical Findings
Stage
pericolic abscess confined by the mesentery of the colon
I
extramesenteric abscess formed following the rupture of a pericolic abscess; the abscess may be walled off by bowel, omentum, mesocolon, pelvic organs and/or peritoneum
II
generalized peritonitis due to the rupture of a pericolic or pelvic abscess into the peritoneal cavity but without free communication between the bowel lumen and the abscess cavity (noncommunicating diverticulitis)
III
free passage of stool through the diverticulum into the peritoneum, resulting in fecal peritonitis (acute communicating diverticulitis)
IV
where:
• Diverticulosis or diverticulitis without perforation could be viewed as Stage 0.
Interpretation:
• The higher the stage, the more serious the disease and the more serious the complications.
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