Acute colonic diverticulitis: a systematic review of diagnostic accuracy

Liljegren, Göran; Chabok, Abbas; Wickbom, M.; Smedh, K.; Nilsson, Kristofer F.

doi:10.1111/j.1463-1318.2007.01238.x

Cited by 112 publications

(74 citation statements)

References 31 publications

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“…In the case of such locations, CT should be given preference over ultrasound alone particularly in the evaluation of the local situation in the case of an indication for emergency surgery. Metaanalyses show that ultrasound and CT have comparable values in the evaluation of diverticular disease [29,30]. However, it is interesting here that the good results for ultrasound in the metaanalyses were primarily due to the fact that the sonographic studies had a higher study quality compared to CT and MRI studies [31].…”

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confidence: 91%

S2k Guidlines for Diverticular Disease and Diverticulitis: Diagnosis, Classification, and Therapy for the Radiologist

Schreyer

Layer

2015

Fortschr Röntgenstr

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Diverticular disease and diverticulitis represent an increasingly common disease especially in patients with advanced age. The German Society of Digestive and Metabolic Diseases (DGVS) as well as the German Society of General and Visceral Surgery (DGAV) in collaboration with the German Radiology Society (DRG) created and published S2k guidelines regarding this topic. Knowledge of the diagnosis and therapy of this common disease is extremely important for the radiologist for the daily clinical routine. In this article we review and discuss the most important clinical situations and algorithms of this disease focusing on radiological topics. Additionally, we introduce the new CCD (classification of diverticular disease) system regarding radiology. Key Points: ??For the diagnosis of a diverticular disease a sectional imaging method should be performed. First choice should be a ?qualified ultrasound examination? followed by CT in uncertain situations or complicated disease. ??Disease classification should be done according the new CCD (Classification of diverticular disease) algorithm. ??Based on this new CCD patients can be stratified into outpatient, in-house patient and surgical treatment therapy. Citation Format: ??Schreyer AG, Layer G. S2k Guidlines for Diverticular Disease and Diverticulitis: Diagnosis, Classification, and Therapy for the Radiologist. Fortschr R?ntgenstr 2015; 187: 676???684

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confidence: 91%

S2k Guidlines for Diverticular Disease and Diverticulitis: Diagnosis, Classification, and Therapy for the Radiologist

Schreyer

Layer

2015

Fortschr Röntgenstr

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“…Much of this information is based on case series data, which have relatively small sample sizes and the preoperative diagnosis was not made using imaging studies. Recent studies suggest that colonic diverticulitis can be correctly diagnosed by computed tomography (CT) scan [6,7,10] , or ultrasonography (US) [11][12][13][14] , and with the use of these imaging studies, right colonic diverticulitis is more common than has been previously assumed [7] . The aim of this study was to evaluate the clinical course and results of medical therapy in patients with right colonic diverticulitis, of which the final diagnosis was based on radiographic evidence from CT or US, or operative findings.…”

Section: Introductionmentioning

confidence: 99%

Image-guided conservative management of right colonicdiverticulitis

Park¹,

Choi²,

Lee³

et al. 2009

WJG

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AIM:To study the clinical outcomes of medical therapy in patients with right colonic diverticulitis. METHODS:The records of 189 patients with right colonic diverticulitis which was finally diagnosed by computed tomography, ultrasonography, or operative findings were retrospectively reviewed. RESULTS:Of the 189 patients hospitalized for right colonic diverticulitis, the stages of diverticulitis by a modified Hinchey classification were 26 patients (13.8%) in stage 0, 139 patients (73.5%) in stage Ⅰ a, 23 patients (12.2%) in stage Ⅰb, and 1 patient (0.5%) in stage Ⅲ. Medical therapy was undertaken in 185 of 189 patients (97.9%). One hundred and eighty three of 185 patients were successfully treated with bowel rest and antibiotics. Two patients in stage Ⅰb required a resection or surgical drainage because of an inadequate response to conservative treatment. Recurrent diverticulitis developed in 15 of 183 patients (8.2%) who responded to medical therapy. All 15 patients who suffered a second attack had uncomplicated diverticulitis, and were successfully treated with medical therapy. CONCLUSION:Our results indicate that right colonic diverticulitis is essentially benign and image-guided conservative treatment is primarily required.

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“…The multiple variable logistic regression analysis estimated odds ratios and 95% confidence intervals for days from admission for each outcome adjusted for confounders. The solution to the regression equation was used to predict the average probability of each outcome for each day following admission (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Average predicted values for each day were plotted to show the trend over 1 -20 days.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis of AD encompasses a broad spectrum of disease states from uncomplicated disease, to pelvic abscess, to feculent peritonitis (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Impact of Operative Delay on Sepsis and Mortality in Patients with Acute Diverticulitis

et al. 2017

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Background: Ideal operative timing for non-emergent, acute diverticulitis (AD) remains unclear. Medical management is initially attempted to convert a high risk urgent surgery to a less morbid elective surgery, or to avoid surgery altogether. A large proportion of patients will fail medical treatment and require colectomy. Objectives: To evaluate the effect of operative delay on sepsis and mortality in patients with AD. Methods: Patients from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database who underwent colectomy with a primary diagnosis of diverticulitis between 2005 and 2014 were included. Multiple patient variables were analyzed to see their combined effect on death and sepsis. Patients undergoing surgical intervention on hospital day 0, emergent cases and those with preoperative sepsis were excluded. The impact of operative delay on mortality and sepsis was evaluated using day from admission as the predictor of the primary outcomes. Secondary outcomes included urinary tract infection (UTI), pneumonia (PNA), need for blood transfusion, septic shock, return to the operating room, length of stay (LOS), readmission, wound dehiscence, and surgical site infections (SSI). Frequency of patient variables was recorded and a multiple variable logistic regression analysis was performed to control for possible confounders. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for primary and secondary outcomes. Results: 32,399 patients underwent colectomy for AD on hospital day 1 -20. Adjusted for other factors, days to operation was found to be a significant predictor for death (OR = 1.038, 95% CI 1.020 -1.057; P < 0.0001) and sepsis (OR = 1.051, 95% CI, 1.035 -1.067; P < 0.0001). Each day in which surgical intervention was delayed was associated with a 3.8% increased risk of mortality and 5.1% increased risk of sepsis. Delay of surgery was also associated with an increased risk of blood transfusion, return to the operating room and increased LOS. Conclusions: Delaying operation for patients with AD has a significant impact on sepsis and mortality. While non-operative approaches may be attempted, with each additional day operative therapy is delayed there is a significant increase in the risk of morbidity and mortality. This data suggests that surgeons should pursue operative therapy earlier in the hospital course to improve patient outcomes.

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Acute colonic diverticulitis: a systematic review of diagnostic accuracy

Abstract: The best evidence for diagnosis of diverticulitis in the literature is on US. Only one small study of good quality was found for CT and for MRI-colonoscopy.

Cited by 112 publications

References 31 publications

S2k Guidlines for Diverticular Disease and Diverticulitis: Diagnosis, Classification, and Therapy for the Radiologist

S2k Guidlines for Diverticular Disease and Diverticulitis: Diagnosis, Classification, and Therapy for the Radiologist

Image-guided conservative management of right colonicdiverticulitis

Impact of Operative Delay on Sepsis and Mortality in Patients with Acute Diverticulitis

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