CT evaluation of appendicitis and diverticulitis. Part II: Diverticulitis

Abstract

CT has become the primary imaging modality for evaluation of possible diverticulitis. In studies of patients taken to surgery for suspected diverticulitis without first undergoing CT, 25±33 % of resected specimens show no inflammation. The overall accuracy of CT in establishing or excluding the diagnosis is between 84 and 99 %. In patients without diverticulitis, an alternative diagnosis is seen in 50±58 % of cases. The appearance of carcinoma with perforation and diverticulitis may be the same, and, as a result, the degree of certainty in the diagnosis should be stated. Techniques include use of either oral and intravenous contrast or rectally administered contrast. No case of colonic perforation due to rectally administered water-soluble contrast for CT has been reported, although there have been cases of perforation using barium and fluoroscopy. All techniques scan the entire abdomen and pelvis since there are frequent alternative diagnoses seen beyond the area of initial pain.

Frequency, Sensitivity, and Specificity of Individual Signs of Diverticulitis on Thin-Section Helical CT with Colonic Contrast Material: Experience with 312 Cases

“…Tables 1 and 2 list the signs considered suggestive of diverticulitis according to previous communications in the literature [4,8,9,18,19,20] and the frequency with which the signs were interpreted as positive, negative, or indeterminate for diverticulitis on CT; the number of true-positive, true-negative, false-positive, and false-negative interpretations; and the sensitivity, specificity, positive predictive value, and negative predictive value of each sign.…”

“…The occurrence in autopsy studies rose from 5% in 1910 to 50% in 1980 [1], and this finding is now present in almost 80% of the population by the age of 85 years [2]. Symptomatic diverticulitis will eventually develop in 10-35% of patients with diverticulosis [3], and approximately 25% of these patients will require surgery [4].…”

“…Colonic contrast material administered through the rectum offers the advantage of evaluation of colonic wall thickness, intraluminal versus extraluminal air, and the "arrowhead" sign [18]. Oral contrast material may not allow evaluation of colonic wall thickness when the colon is partially collapsed [4]. In addition, it takes up to 2 hr for oral contrast material to opacify the large bowel.…”

Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: Meta-analysis of test accuracy

“…Reported sensitivities and specificities vary, both for US and CT [5,7]. A systematic review of prospective studies may be able to summarise the diagnostic accuracy of both investigations, providing estimates with greater precision.…”

Primärdiagnostik der akuten Sigmadivertikulitis

“…Eine Symptomatik im Sinne einer Divertikulitis entwickeln 10 -35 % dieser Patienten [3]. 25 % der Divertikulitispatienten werden operiert [4].…”