Surgical management in acute diverticulitis and its association with multi-detector CT, modified Hinchey classification, and clinical parameters

Bates, ‬David D. B.; Fernandez, Marina Bernal; Ponchiardi, Cecilia; Plato, Michael; Teich, Joshua P.; Narsule, Chaitan K.; Anderson, Stephan W.; Gupta, Avneesh; LeBedis, Christina A.

doi:10.1007/s00261-017-1422-y

Cited by 27 publications

(25 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…CT scan was performed for diagnosis. CT finding was described based on modified Hinchey classification of diverticulitis [12]: Grade Ia, appendiceal wall thickening with periappendiceal soft tissue change; Grade Ib, Ia + periappendiceal abscess or ileo or cecal edema; grade II, Ia + distant abscess (generally deep in the pelvis or interloop regions); and grade III, free gas associated with localized or generalized ascites and possible peritoneal wall thickening.…”

Section: Methodsmentioning

confidence: 99%

Early versus late surgical management for complicated appendicitis in adults: a multicenter propensity score matching study

Kim

Park

et al. 2019

Ann Surg Treat Res

View full text Add to dashboard Cite

Purpose Surgeons may be uncertain about the optimal timing of appendectomy to decrease complications, especially for complicated appendicitis. The aim of the study was to compare clinical outcomes between early and late surgery for complicated appendicitis. Methods A prospectively maintained database of complicated appendicitis was queried. Elective interval surgery (EIS) group and early surgery (ES) were matched with propensity score and marked with a prefix ‘p.’ Patient characteristics and surgical outcomes were compared. Results The propensity score-matched EIS group had a lower chance to underwent ileo-cecectomy or right hemicolectomy (1.5% vs . 6.9%, P = 0.031), a tendency of lower rate of postoperative complication (6.9% vs . 13.7%, P = 0.067), a lower rate of wound infection (1.5% vs . 8.4%, P = 0.010), and shorter postoperative hospital stay (3.72 days vs . 5.82 days, P < 0.001) than the propensity score-matched ES group. Multivariate analysis showed that delayed surgery for more than 48 hours or urgent surgery due to failure of EIS and open conversion were independent risk factors for postoperative complications (P = 0.001 and P = 0.025, respectively). In subgroup analysis, high American Society of Anesthesiologists physical status classification and distant abscess or generalized ascites in initial CT increased the risk of failure of EIS. Conclusion EIS can be a useful option for selected adult patients with complicated appendicitis.

show abstract

Section: Methodsmentioning

confidence: 99%

Early versus late surgical management for complicated appendicitis in adults: a multicenter propensity score matching study

Kim

Park

et al. 2019

Ann Surg Treat Res

View full text Add to dashboard Cite

show abstract

“…CT scan grades the severity of diverticulitis; several CT classifications have been proposed: Ambrosetti, Hynchey, WSES. Currently the modified Hynchey's classification remains the most widely used, but it is insufficient to cover all clinical presentations [31][32][33]. CT scan should be descriptive taking into consideration the details of all the signs that might play a role in the evaluation of AD.…”

Section: Computer Tomographymentioning

confidence: 99%

What’s New in Diagnosing Diverticular Disease

Štimac

Nardone²,

Mazzari

et al. 2020

JGLD

View full text Add to dashboard Cite

In this session different issues for the diagnosis of diverticular disease (DD) were considered including “Biomarkers”, “Computer tomography”, “Ultrasonography in detecting acute diverticulitis”, “Endoscopy” and “The DICA classification: a new predictive tool in managing diverticular disease”. Most patients affected by DD suffer from recurrent attacks of abdominal pain without evidence of an active inflammatory process, causing a difficult differential diagnosis with other intestinal conditions. Several biomarkers, serological, fecal, urinary and genetic were considered, but recent studies confirmed that only CRP and fecal calprotectin are matching with the criteria for an ideal biomarker for DD. Colonoscopy still remains the gold standard for the diagnosis of DD, playing a key role in many clinical settings, such as colonic diverticular bleeding, or to differentiate inflammatory bowel disease (IBD) and segmental colitis associated with diverticulosis (SCAD); Moreover, in 2015 has been developed the DICA (Diverticular Inflammation and Complication Assessment) endoscopic classification that considers 10 different parameters, each one with a score, and the sum of items scores represents the severity of the disease; in this way the endoscopic exam would be able to predict the outcome of DD for each patient. On the other hand, computer tomography (CT) is the gold standard for acute diverticulitis (AD) with an excellent sensitivity and specificity; recently, metanalysis of prospective studies have shown that intestinal ultrasonography (IUS) and CT have the same sensitivity for the diagnosis of an AD and the advantage is that IUS is less expensive, non-invasive and easily accessible.

show abstract

“…Some authors recommend use of contrast‐enhanced standard‐dose CT (SDCT) with rectal contrast medium for the evaluation of suspected diverticulitis. Recent studies have used contrast‐enhanced SDCT but without oral or rectal contrast, and there is no consensus regarding CT examination modalities.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of acute diverticulitis with unenhanced low-dose CT

et al. 2020

View full text Add to dashboard Cite

Background: The aim of this study was to evaluate the diagnostic accuracy of unenhanced low-dose CT (LDCT) in acute colonic diverticulitis in comparison with contrast-enhanced standard-dose CT (SDCT). Methods: All patients with clinically suspected diverticulitis who underwent LDCT followed by SDCT between January and October 2017 were evaluated prospectively. CT examinations were assessed for signs of diverticulitis, complications and other differential diagnoses by three independent radiologists (two consultants and one fourth-year resident) using SDCT as the reference method. Sensitivity and specificity were calculated and Cohen's coefficient was used for agreement analyses. Results: Of the 149 patients included (mean age 66⋅7 years, M : F ratio 0⋅4), 107 (71⋅8 per cent) had imaging consistent with diverticulitis on standard CT. Sensitivity and specificity values for a diverticulitis diagnosis using LDCT were 95-99 and 86-100 per cent respectively, and respective values for identification of complications were 58-73 and 78-100 per cent. The corresponding values among the three readers for diagnosis were 0⋅984, 0⋅934 and 0⋅816, whereas values for complications were 0⋅680, 0⋅703 and 0⋅354. Of the 26 patients who presented with other causes of abdominal symptoms identified on standard CT, 23 were diagnosed correctly on LDCT. Missed cases included splenic infarction (1) and segmental colitis (2). Conclusion: The diagnostic accuracy of LDCT was high for the presence of acute diverticulitis. However, as signs of complicated disease can be missed using the low-dose protocol, use of LDCT as a primary examination method should not preclude SDCT when complications may be suspected.

show abstract

Surgical management in acute diverticulitis and its association with multi-detector CT, modified Hinchey classification, and clinical parameters

Abstract: Specific CT imaging features and modified Hinchey classification are associated with subsequent surgical management in patients with acute diverticulitis.

Cited by 27 publications

References 19 publications

Early versus late surgical management for complicated appendicitis in adults: a multicenter propensity score matching study

Early versus late surgical management for complicated appendicitis in adults: a multicenter propensity score matching study

What’s New in Diagnosing Diverticular Disease

Diagnostic accuracy of acute diverticulitis with unenhanced low-dose CT

Contact Info

Product

Resources

About