Application of a modified Neff classification to patients with uncomplicated diverticulitis L. Mora Lopez*, S. Serra Pla*, X. Serra-Aracil*, E. Ballesteros† and S. Navarro‡ *Coloproctology Unit of General and Digestive Surgery Service, Hospital Universitari Parc Tauli (Sabadell), †Radiodiagnosis Service, Hospital Universitari Parc Tauli (Sabadell) and ‡Chief of General and Digestive Surgery Service, Hospital Universitari Parc Tauli (Sabadell), Sabadell, Spain Received 20 January 2013; accepted 7 April 2013; Accepted Article online 8 October 2013 Abstract Aim Severity of acute diverticulitis (AD) has tradition- ally been assessed using the Hinchey classification; however, this classification is predominantly a surgical one. The Neff classification provides an alternative clas- sification 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 under- went emergency abdominal CT and were assigned a Neff stage, including a modification (mNeff) to Neff Stage I. The Neff stages used were: Stage 0, uncom- plicated diverticulitis; Diverticula, thickening of the wall, increased density of the pericolic fat; Stage I, locally complicated (our modification included substag- es 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 sys- temic 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 treat- ment. After applying the exclusion criteria, 68 were eventually assigned to an outpatient programme. Sixty- four (94%) successfully completed the outpatient treat- ment protocol; four patients were readmitted. Conclusion Our mNeff classification allowed selected patients with AD to be successfully managed in an out- patient programme. Keywords Acute diverticulitis, Neff’s classification, out- patient What does this paper add to the literature? It describes a modified classification for diverticulitis that allows accurate selection of patients for stage-spe- cific treatment. Introduction Clinically acute diverticulitis (AD) can be catogorized as uncomplicated when the inflammation is localized or as complicated when the inflammation is accompanied by the appearance of a gross perforation, abscess, peritoni- tis, fistula or stricture [1–3]. Imaging tests are used to confirm the diagnosis of AD [1,4]. Currently, CT is the gold-standard diagnostic option [1,4,5]. Although doubts have been raised about the need for CT in all patients with suspicion of uncomplicated AD [6], many authors recommend it as the diagnostic test of choice as it may identify patients at risk of complications that may cause conservative treatment to fail [7–10]. The Hinchey classification has traditionally been used to catogorize diverticulitis severity [11]. However, Hin- chey’s predominantly surgical classification (Table 1) may not provide the level of detail necessary to indicate the presence, location and severity of the disease to guide subsequent patient management. Alternative clasi- fications to that of Hinchey have been described but in general we consider them to be impractical [12–15]. In this study we propose a new classification, based on that of Neff [16], which is based principally on radiological findings obtained with CT. The Neff Correspondence to: Laura Mora Lopez, MD, Coloproctology Unit of General and Digestive Surgery Service, Hospital Universitari Parc Tauli, Parc Tauli s/n, Sabadell (Barcelona) Spain. E-mail: lmora@tauli.cat Colorectal Disease ª 2013 The Association of Coloproctology of Great Britain and Ireland. 15, 1442–1447 1442 Original article doi:10.1111/codi.12449