Acute colonic diverticulitis in a community-based hospital: CT evaluation in 138 patients

Abstract

The purpose of this research is to retrospectively analyze computed tomography (CT) findings of patients with acute colonic diverticulitis presented to a community-based hospital. During a 1-year period from May 2004 to April 2005, CT scans of 138 patients [mean age 62.3 years (SD 14.9), range 30-100 years] with clinical diagnosis of diverticulitis were analyzed. Of the 138 patients, 136 CT scans were performed with oral and intravenous contrast administration except in two patients who received only oral contrast. Twenty-eight patients (28/138, 20.3%) had diverticulosis, 77 (77/138, 55.8%) had uncomplicated diverticulitis, and 33 (33/138, 23.9%) had complications. Left-sided diverticulitis predominated (137/138, 99.3%). Colonic diverticula were identified in almost every patient (136/138, 98.6%); the majority had moderate colonic wall thickening (82/110, 74.5%) and moderate pericolonic inflammation (65/110, 59.1%). Isolated extraluminal air bubbles (19/33, 57.6%) were the most commonly seen complication, followed by abscess (15/33, 45.5%). Bowel obstruction (2/33, 6.1%) and pylephlebitis (1/33, 3.0%) were less commonly seen but were observed as significant abnormalities. Complicated diverticulitis was less prevalent in this community hospital setting, in contrast with referral medical centers. Common CT findings of diverticulitis included presence of diverticula, moderate wall thickening, and pericolonic inflammation. Isolated air bubbles were the most commonly seen complication followed by abscess.

Challenging a classic myth: pneumoperitoneum associated with acute diverticulitis is not an indication for open or laparoscopic emergency surgery in hemodynamically stable patients. A 10-year experience with a nonoperative treatment

“…This datum should not be surprising. Kaewlai and Nazinitsky [34] found patients with ''free air'' at CT scan to have the same recurrence rate as the rest of the population. In another study, only 38% of patients who underwent laparoscopic lavage/drainage for Hinchey III AD finally had to undergo elective resection surgery [35].…”

A 37-Year-old Patient Presenting with Pneumaturia: A Case Study

“…However, most of the studies published after 2005 have focused on the role of CT in the early diagnosis of acute colonic diverticulitis and its complications (2–4). Pneumaturia is sometimes the first symptom of CVF and should always raise the suspicion of this rare complication.…”

Development and validation of algorithms to identify acute diverticulitis

“…In Western countries, diverticular disease is one of the most prevalent medical conditions in the elderly . During a symptomatic episode, patients typically present with generalized malaise, abdominal pain, fever, nausea, vomiting, anorexia, and bowel habit changes . In such cases, a diagnosis based solely on clinical indications is often incorrect , and the literature reports high misdiagnosis rates ranging from 34 to 67% …”

“…Computed tomography (CT) has radically changed the way diverticulitis is diagnosed and treated . CT can show diverticulitis in an early stage, reveal complications with high sensitivity, forecast risk of recurrence, and guide therapy such as percutaneous abscess drainage .…”

“…1 During a symptomatic episode, patients typically present with generalized malaise, abdominal pain, fever, nausea, vomiting, anorexia, and bowel habit changes. 2,3 In such cases, a diagnosis based solely on clinical indications is often incorrect 1,[4][5][6][7][8][9][10] , and the literature reports high misdiagnosis rates ranging from 34 to 67%. 3,11 Computed tomography (CT) has radically changed the way diverticulitis is diagnosed and treated.…”