Acute left colonic diverticulitis—compared performance of computed tomography and water-soluble contrast enema

Ambrosetti, P.; Jenny, Alexandra; Becker, Christophe; Terrier, François; Morel, Philippe

doi:10.1007/bf02236631

Cited by 208 publications

(132 citation statements)

References 19 publications

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“…The exclusion was based on substantial overlap in time frames of patient recruitment by the same investigators in the same institution as well as identical descriptions of patients with false-positive diagnoses of diverticulitis. Only the most comprehensive publication by that group of authors (Ambrosetti et al [20], published in 2000) was included in the analysis. There was complete agreement among the authors as to the inclusion of the studies.…”

Section: Evidence-based Practice: Colonoscopy After Ct Diagnosis Of Dmentioning

confidence: 99%

Colonoscopy after CT Diagnosis of Diverticulitis to Exclude Colon Cancer: A Systematic Literature Review

Sai¹,

Velayos²,

Neuhaus³

et al. 2012

Radiology

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Purpose:To estimate the prevalence of underlying adenocarcinoma of the colon in patients in whom acute diverticulitis was diagnosed at computed tomography (CT) and to compare that to the prevalence of colon cancer in the general population. Materials and Methods:A comprehensive literature review was performed to find articles in which patients with CT diagnosis of acute diverticulitis underwent surgery, colonoscopy, or barium enema study within 24 weeks. Patients meeting these criteria were included for analysis. A pooled prevalence of cancer was calculated on the basis of a random effects model and compared qualitatively with the prevalence of cancer in the general population. The 95% confidence intervals around the prevalence of cancer in the study populations were determined. Results:Ten articles met the inclusion criteria. Data from these articles included only 771 patients who underwent surgery, colonoscopy, or barium enema study within 24 weeks of diagnosis. Fourteen patients were found to have colon cancer, for a prevalence of 2.1% (95% confidence interval: 1.2%, 3.2%). This compares to a calculated estimated prevalence of 0.68% among U.S. adults older than 55 years.

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Section: Evidence-based Practice: Colonoscopy After Ct Diagnosis Of Dmentioning

confidence: 99%

Colonoscopy after CT Diagnosis of Diverticulitis to Exclude Colon Cancer: A Systematic Literature Review

Sai¹,

Velayos²,

Neuhaus³

et al. 2012

Radiology

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“…Computed tomography (CT) has emerged as the imaging modality of choice given its high sensitivity and specificity for the diagnosis of diverticulitis, with some studies reporting up to 100% in either measure. [3][4][5][6][7][8] Computed tomography findings of diverticula, inflammation of pericolic fat, bowel wall thickness greater than 4 mm and/or pericolic fluid/abscess are highly suggestive of acute diverticulitis. 1,8,9 A CT scan also provides prognostic information and guides management by determining whether the diverticulitis is complicated by abscess, fistula formation, stricture/obstruction or free rupture.…”

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confidence: 99%

Colonoscopy after CT-diagnosed acute diverticulitis: Is it really necessary?

Rosenfeld

Brown

et al. 2015

cjs

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Background: Computed tomography (CT) scans are commonly used to diagnose acute diverticulitis, but there are overlapping features between diverticulitis and colorectal cancer (CRC) on imaging studies. Hence, colonoscopy is typically recommended after an episode of acute diverticulitis to rule out underlying malignancy. Currently, 64-slice multidetector CT scanners are capable of providing higher-resolution images and may be able to distinguish malignancy from diverticular inflammation. We aimed to determine the prevalence of CRC among patients with CT-diagnosed acute diverticulitis. Methods:We performed a retrospective study of patients with acute diverticulitis diagnosed on CT scan between December 2005 and December 2010 at St. Paul's Hospital, Vancouver, BC. Nonresidents were excluded. We reviewed CT scan reports that included the term "diverticulitis," reports of follow-up colonic evaluation within 1 year of diagnosis and pathology results. We queried the provincial cancer registry to ensure no cases of CRC were missed.Results: A total of 293 patients had acute diverticulitis diagnosed on CT scan, but 8 were nonresidents and were excluded. Of the 285 included in the analysis, the mean age was 59.4 ± 15.1 years, and 167 (58.6%) were men. Among the 114 patients who underwent follow-up evaluation, malignancy was diagnosed in 4 (3.5%). The overall prevalence of malignancy among patients with CT-diagnosed diverticulitis was 1.4%. Conclusion:Routine endoscopic evaluation after an episode of diverticulitis diagnosed with high-resolution CT scan does not appear to be necessary. Selective approach in patients with protracted clinical course or those with mass lesion/ obstruction on CT scan may be of benefit.Contexte : La tomodensitométrie (TDM) est couramment utilisée pour le diagnostic de la diverticulite aiguë, mais des caractéristiques sont communes à la diverticulite et au cancer colorectal (CCR) aux épreuves d'imagerie. On recommande donc en général la coloscopie après un épisode de diverticulite aiguë pour écarter un diagnostic de cancer sous-jacent. À l'heure actuelle, les appareils de TDM multidétecteurs à 64 barrettes peuvent fournir des images de haute résolution et permettent même de distinguer le cancer d'une inflammation diverticulaire. Nous avons voulu déterminer la prévalence du CCR chez les patients ayant présenté une diverticulite aiguë diagnostiquée par TDM. Résultats : En tout, 293 patients ont reçu un diagnostic de diverticulite à l'aide de la TDM; 8 étaient des non-résidents et ont été exclus. Parmi les 285 patients inclus dans l'analyse, l'âge moyen était de 59,4 ± 15,1 ans et 167 (58,6 %) étaient des hommes. Parmi les 114 patients qui ont subi un examen de suivi, le cancer a été diagnostiqué chez 4 (3,5 %). La prévalence globale du cancer chez les patients porteurs d'un diagnostic de diverticulite posé par TDM était de 1,4 %. Conclusion :L'évaluation endoscopique de routine après un épisode de diverticulite diagnostiquée à l'aide d'une TDM de haute résolution ne semble pas nécessaire. Une approc...

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“…CT has been shown to be more sensitive than water-soluble contrast enema in the assessment of acute diverticulitis [10,11] and can predict the failure of medical treatment and the likelihood of secondary complications [12]; it also has the advantage of allowing the detection of other pathologies. Ultrasound may be used as an alternative investigation, depending on the local expertise [6].…”

Section: Introductionmentioning

confidence: 99%

Management of Acute Diverticulitis and its Complications

Welbourn

Hartley

2014

Indian J Surg

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Colonic diverticular disease is a common condition, and around a quarter of people affected by it will experience acute symptoms at some time. The most common presentation is uncomplicated acute diverticulitis that can be managed conservatively with bowel rest and antibiotics. However, some patients will present with diverticular abscesses or purulent or faeculent peritonitis due to perforated diverticular disease. Whilst most mesocolic abscesses can be managed with percutaneous drainage alone, pelvic abscesses are associated with a higher rate of future complications and usually require percutaneous drainage followed by interval sigmoid resection. Patients who require emergency surgery for complicated acute diverticulitis most commonly undergo a Hartmann's procedure, although resection with primary anastomosis and laparoscopic peritoneal lavage have emerged as alternative treatment options for patients with purulent peritonitis in recent years. However, robust evidence from randomized trials is lacking for these alternative procedures, and the studies that have reported good outcomes from them have included carefully selected patient groups. There has been a move away from recommending elective prophylactic colectomy after two episodes of acute diverticulitis in the light of evidence that most patients will not experience a significant recurrence of their symptoms; elective surgery is indicated for those with ongoing symptoms, pelvic abscesses, complications-such as fistulating disease, strictures or recurrent diverticular bleeding-and those who are at high risk of perforation during future episodes, for example, due to immunosuppression, chronic renal failure or collagen-vascular diseases.

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Acute left colonic diverticulitis—compared performance of computed tomography and water-soluble contrast enema

Cited by 208 publications

References 19 publications

Colonoscopy after CT Diagnosis of Diverticulitis to Exclude Colon Cancer: A Systematic Literature Review

Colonoscopy after CT Diagnosis of Diverticulitis to Exclude Colon Cancer: A Systematic Literature Review

Colonoscopy after CT-diagnosed acute diverticulitis: Is it really necessary?

Management of Acute Diverticulitis and its Complications

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