Colonic diverticulitis: a prospective analysis of diagnostic accuracy and clinical decision‐making

Toorenvliet, Boudewijn R.; Bakker, Rutger F. R.; Breslau, Paul J.; Merkus, J. W. S.; Hamming, Jaap F.

doi:10.1111/j.1463-1318.2009.01778.x

Cited by 81 publications

(88 citation statements)

References 32 publications

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“…This recommendation is based on the fact that a lack of imaging results in an increased di- agnostic error rate. Therefore, clinical diagnosis without imaging reaches sensitivities of only between 64 % and 71 % [24,25]. "Qualified abdominal ultrasound" should be used as the primary cross-sectional imaging procedure for the initial and follow-up diagnostic workup of acute diverticulitis.…”

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confidence: 99%

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

Schreyer

Layer

2015

Fortschr Röntgenstr

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“…As a consequence, however, without CT-scan or operation, no classification of diverticulitis for the vast majority of patients exists, because the hitherto used classifications (Hinchey, Hansen-Stock) were based on either operative or CT-criteria. On the other hand, merely ´clinical diagnosis´ of diverticulitis is insufficient (sensitivity ~65%) and potentially misleading [4,[37][38][39][40]. Also apostrophized as ´left sided appendicitis´, the triad (i) spontaneous pain in the left lower quadrant, exaggerated by movements, (ii) an inflammatory reaction (CRP, WBC, temperature) and (iii) local guarding upon palpation, is unspecific, time-dependent, and variable, and thus may raise the suspicion of diverticulitis but neither satisfies contemporary diagnostic needs nor excludes most differential diagnoses [4,29].…”

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confidence: 99%

Statement of the Section Internal Medicine of the DEGUM – Ultrasound Obtains Pole Position for Clinical Imaging in Acute Diverticulitis

2015

Ultraschall in Med

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This paper reviews and interprets the role of ultrasonography in view of the recently published Guideline on diverticular disease of the Consensus conference of the German Societies of Gastroenterology (DGVS) and Visceral Surgery (DGAV) implying a new classification of diverticular disease (CDD). Qualified US is not only equipotent to qualified CT and frequently effectual for diagnosis but considers relevant legislation for radiation exposure protection. Unsurpassed resolution allows detailed resolution thereby allowing to differentiate and stratify the relevant types of diverticular disease. Subsequently, US is considered the first choice of imaging in diverticular disease. Vice versa, CT has definite indications in unclear / discrepant situations ? or insufficient US-performance.

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“…It is notable that during the time period of the study, a total of 1,257 patients were admitted with acute diverticulitis; it is unlikely that only 100 of these patients required surgical intervention, thereby raising the possibility of selection bias within the study. There have also been a number of systematic literature reviews regarding laparoscopic lavage, all of which have concluded that the procedure was successful in controlling sepsis in the vast majority of patients, with low morbidity and mortality rates, and could therefore be a valid alternative to a Hartmann's procedure [8,[57][58][59]. However, in general, the published studies included were of low methodological quality.…”

Section: The Role Of Laparoscopic Peritoneal Lavagementioning

confidence: 99%

“…Patients presenting with clinical features of acute diverticulitis are increasingly being investigated by computed tomography (CT), as studies have shown that the accuracy of clinical diagnosis in diverticulitis is low [8,9]. 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.…”

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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Colonic diverticulitis: a prospective analysis of diagnostic accuracy and clinical decision‐making

Abstract: The accuracy of the clinical diagnosis for colonic diverticulitis is low. Ultrasound and computed tomography have superior diagnostic accuracy but these examinations rarely change the initial management proposal.

Cited by 81 publications

References 32 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

Statement of the Section Internal Medicine of the DEGUM – Ultrasound Obtains Pole Position for Clinical Imaging in Acute Diverticulitis

Management of Acute Diverticulitis and its Complications

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