CT colonography evaluation of the relationship between colon anatomy and diverticula

Abstract

Objectives: In this study, we aimed at investigating the relationship between diverticula and in vivo colonic features such as total colon length (TCL), using CTC. We also evaluated polyps, neoplastic lesions and the correlation among them. Methods: This retrospective study considered a series of patients who underwent CTC in our Hospital from 2010 to 2018. We evaluated TCL, the length of each colon segments and sigmoid colon diameter using dedicated software. We verified the presence of diverticula, polyps and neoplasm and measured the number of diverticula using a five-point class scale, evaluating the colonic segments involved by the disease and the number of diverticula for each segment. A logistic regression model was used to analyse the relationship between diverticula and the patients’ age, sigmoid colonic diameter and the length of each colonic segments. Results: The population finally included 467 patients, 177 males and 290 females (average age of 67 ± 12; range 45–96). The mean TCL was 169 ± 25 cm (range 115–241 cm). Out of the 467, 323 patients (69%) had at least one analyse. The patients with diverticula had a mean TCL significantly shorter than patients without diverticula (164 ± 22 vs 181 ± 27 cm; p = 0.001). Among the different variables, sigmoid colon length, sigmoid colon diameter and patient’s age were correlated with diverticula (p < 0.01). Otherwise there is no association among diverticula, polyps and neoplasm. Conclusions: The presence of colonic diverticula was significantly inversely correlated with TCL.The TCL was not significantly correlated with polyps and cancers. Advances in knowledge: The presence of colonic diverticula was significantly inversely correlated with total colon length, and in particular they significantly decreased with increasing colon length; our observation could contribute to the comprehension of diverticula pathogenesis.

Transverse colon diverticulitis mimicking acute appendicitis

“…Colonoscopy, however, is warranted after healing of acute diverticulitis, prior to elective surgery, and in atypical cases suggesting other diagnoses. Perforation or abscess must be excluded before colonoscopy 7 17 18…”

“…According to a cadaveric study, mean length of the transverse colon is 50.2 cm and its mobility is dependent on the height of the mesentery from the root of the mesentery on the posterior abdominal wall to the mesenteric border of the transverse colon and the colonic length 23. According to Flor et al , who used CT colonography to investigate the relationship between diverticula and in vivo colonic features such as total colon length, the mean length of the transverse colon is 56 cm and is rarely associated with diverticula 18 23…”