Impact of CT imaging on predicting the surgical management of acute diverticulitis

Abstract

PurposeThe incidence of colonic diverticular disease is increasing, and several grading systems based on CT findings have been developed. The objective of this study was to define the impact of various CT findings of colonic diverticulitis and to demonstrate which factors affect the need for operative treatment.MethodsThree hundred fifty-seven patients diagnosed with colonic diverticulitis from January 2010 to July 2016 were retrospectively evaluated. Patients were excluded if pure diverticulosis, diverticular bleeding, colon cancer, or relevant data deficiencies, and the remaining patients (n = 178) were reviewed. Patients were categorized into a successful nonoperation group and an operation group. The operation group was then matched 1:2 with the nonoperative group based on age, gender, American Society of Anesthesiologists physical status classification, and body mass index.ResultsAfter propensity score matching, there were no significant differences regarding patients' demographic characteristics between the 2 groups. Left location was more associated with need for operation than the right side (79.2% vs. 31.3%, P < 0.001). CT findings such as distant intraperitoneal air, pericolic air, and free fluid were significantly more apparent in the operation group. When these factors were evaluated in a multivariate analysis, distant intraperitoneal air showed statistical significance (P = 0.046) and pericolic air and left location a significant trend (P = 0.071 and P = 0.067, respectively).ConclusionThis study suggests that distant intraperitoneal air is the most important factor in the need for surgery in patients with colonic diverticulitis. Further study will be able to identify more detailed CT findings and verify their significance, and will be helpful in designing practical scoring and classification systems.

Predictive factors for conservative treatment failure of right colonic diverticulitis

“…Although treatment decision for colonic diverticulitis has been largely based on the Hinchey classification [ 3 ], in numerous cases, the patients' symptoms are incongruent with the Hinchey classification or failure in management via analysis based on the Hinchey classification. Furthermore, conservatively managed patients generally experience repeated symptoms, aggravated complications, and reduced quality of life.…”

“…The treatment strategy for colonic diverticulitis is determined based on the Hinchey radiological grades [ 3 4 ]. However, this classification has limitations regarding the estimation of symptom severity and prediction of conservative management failure among select patients.…”

Surgical approach for right‐sided colonic diverticular bleeding: A single‐center review of 43 consecutive cases

“…Shin et al described that intraperitoneal air is an important factor for the indication of surgical treatment. 13 However, CE-CT does not have a high positive rate of extravasation (15%-36%) despite being often performed for the diagnosis of diverticular bleeding. 13,14 Therefore, CE-CT prior to colonoscopy is not recommended for all patients with acute diverticular bleeding.…”

What’s New in Diagnosing Diverticular Disease

“…CT is a significant predictor of surgery during the first attack, the presence of extraintestinal gas ≥5 mm being correlated with unfavourable outcome of nonsurgical treatment [34]. Length of involved colon >5 cm and retroperitoneal abscess were associated with diverticulitis recurrence: distant intraperitoneal air is the most important factor predicting surgical treatment [35,36]. CT colonography (CTC) recently has been proposed as a diagnostic test in patients recovering from an episode of AD; CTC should be performed at least 2 or 3 months after the acute episode of diverticulitis.…”