CT imaging for prediction of complications and recurrence in acute uncomplicated diverticulitis

Thorisson, Arnar; Smedh, Kennet; Torkzad, Michael R.; Påhlman, Lars; Chabok, Abbas

doi:10.1007/s00384-015-2423-3

Cited by 29 publications

(29 citation statements)

References 16 publications

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“…That being said, a recent re‐evaluation by Thorisson et al . of the CT imaging in the RCT by Chabok et al . has demonstrated that 7% of the CT scans had missed complications such as abscess or free air.…”

Section: Discussionmentioning

confidence: 99%

Antibiotics vs no antibiotics in the treatment of acute uncomplicated diverticulitis – a systematic review and meta‐analysis

Tandon

Fretwell²,

Nunes

et al. 2018

Colorectal Disease

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Section: Discussionmentioning

confidence: 99%

Antibiotics vs no antibiotics in the treatment of acute uncomplicated diverticulitis – a systematic review and meta‐analysis

Tandon

Fretwell²,

Nunes

et al. 2018

Colorectal Disease

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“…There is little evidence, however, whether pericolic or free air alone is an indication for exploration or not. If extraluminal air is used as a surrogate marker for abdominal exploration, there are five retrospective and three prospective cohort studies with a total of 1470 patients [89][90][91][111][112][113][114][115]. Most of the studies are of poor quality with a low number of patients (Data S4; 4.1).…”

Section: Should a High-fibre Diet Be Recommended Following An Episodementioning

confidence: 99%

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

Schultz

Azhar

Binda³

et al. 2020

Colorectal Disease

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172

177

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Aim The goal of this European Society of Coloproctology (ESCP) guideline project is to give an overview of the existing evidence on the management of diverticular disease, primarily as a guidance to surgeons. Methods The guideline was developed during several working phases including three voting rounds and one consensus meeting. The two project leads (JKS and EA) appointed by the ESCP guideline committee together with one member of the guideline committee (WB) agreed on the methodology, decided on six themes for working groups (WGs) and drafted a list of research questions. Senior WG members, mostly colorectal surgeons within the ESCP, were invited based on publication records and geographical aspects. Other specialties were included in the WGs where relevant. In addition, one trainee or PhD fellow was invited in each WG. All six WGs revised the research questions if necessary, did a literature search, created evidence tables where feasible, and drafted supporting text to each research question and statement. The text and statement proposals from each WG were arranged as one document by the first and last authors before online voting by all authors in two rounds. For the second voting ESCP national representatives were also invited. More than 90% agreement was considered a consensus. The final phrasing of the statements with < 90% agreement was discussed in a consensus meeting at the ESCP annual meeting in Vienna in September 2019. Thereafter, the first and the last author drafted the final text of the guideline and circulated it for final approval and for a third and final online voting of rephrased statements. Results This guideline contains 38 evidence based consensus statements on the management of diverticular disease. Conclusion This international, multidisciplinary guideline provides an up to date summary of the current knowledge of the management of diverticular disease as a guidance for clinicians and patients.

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“…Only one previous study assessed CT imaging-based predictive factors for the progression of uncomplicated diverticulitis into complicated diverticulitis [8]. In that study, only four uncomplicated diverticulitis patients progressed into complicated diverticulitis or needed emergency surgery within 1 year.…”

Section: Discussionmentioning

confidence: 99%

Predictive factors on CT imaging for progression of uncomplicated into complicated acute diverticulitis

Dijk

Daniels

Nio

et al. 2017

Int J Colorectal Dis

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PurposeSince outpatient treatment and omitting antibiotics for uncomplicated acute colonic diverticulitis have been proven to be safe in the majority of patients, selection of patients that may not be suited for this treatment strategy becomes an important topic. The aim of this study is to identify computed tomography (CT) imaging predictors for a complicated disease course of initially uncomplicated acute diverticulitis.MethodsCT imaging from a randomized controlled trial (DIABOLO study) of an observational vs. antibiotic treatment strategy of first-episode uncomplicated acute diverticulitis patients was re-evaluated. For each patient that developed complicated diverticulitis within 90 days after randomization, two patients with an uncomplicated disease course were randomly selected. Two abdominal radiologists, blinded for outcomes, independently re-evaluated all CTs.ResultsOf the 528 patients in the DIABOLO trial, 16 patients developed complications (abscess > 5 cm, perforation, bowel obstruction) within 90 days after randomization. In the group with a complicated course of initially uncomplicated diverticulitis, more patients with fluid collections (25 vs. 0%; p = 0.009) and a longer inflamed colon segment (86 ± 26 mm vs. 65 ± 21 mm; p = 0.007) were observed compared to an uncomplicated course of disease. Pericolic extraluminal air was no predictive factor.ConclusionFluid collections and to a lesser extent the length of the inflamed colon segment may serve as predictive factors on initial CT for a complicated disease course in patients with uncomplicated acute colonic diverticulitis. These findings may aid in the selection of patients not suitable for outpatient treatment and treatment without antibiotics.

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CT imaging for prediction of complications and recurrence in acute uncomplicated diverticulitis

Cited by 29 publications

References 16 publications

Antibiotics vs no antibiotics in the treatment of acute uncomplicated diverticulitis – a systematic review and meta‐analysis

Antibiotics vs no antibiotics in the treatment of acute uncomplicated diverticulitis – a systematic review and meta‐analysis

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

Predictive factors on CT imaging for progression of uncomplicated into complicated acute diverticulitis

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