The diagnostic criteria for right colonic diverticulitis: prospective evaluation of 100 patients

• Published in: International journal of colorectal disease Vol. 23; no. 12; pp. 1151 - 1157
• Main Authors: Lee, In Kyu, Jung, Seung Eun, Gorden, D. Lee, Lee, Yoon Suk, Jung, Dae Young, Oh, Seong Taek, Kim, Jun-Gi, Jeon, Hae Myung, Chang, Suk Kyun
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.12.2008; Springer; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Appendicitis - diagnosis; Biological and medical sciences; Diverticulitis, Colonic - diagnosis; Diverticulitis, Colonic - diagnostic imaging; Female; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Hepatology; Humans; Internal Medicine; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Original Article; Other diseases. Semiology; Predictive Value of Tests; Proctology; Prospective Studies; Sensitivity and Specificity; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery; Tomography, X-Ray Computed; Ascending colon; Diagnosis; Diverticulitis; Spiral computed tomography; Human; Diverticulitis . Ascending colon; Gastroenterology; Right; Medical imagery; Digestive diseases; Intestinal disease; Helical computed tomography; Colon
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-008-0512-2

Background and aims In this study, we evaluate prospective diagnostic criteria and propose a clinical scoring system for the evaluation of patients suspected to have right colonic diverticulitis (RCD) prospectively. Patients and methods One hundred adult patients, who were clinically suspected to have appendicitis or RCD, and in whom we were not able to preoperatively rule out appendicitis, were examined prospectively. Patients were scored upon clinical presentation based on major diagnostic criteria included (1) no migration pain to the right lower quadrant; (2) a leukocyte count <10,000/mm 3 ; (3) lateralized abdominal pain, and (4) a history of right colonic diverticulum (two points each). Minor diagnostic criteria (one point each) included (1) a history of right lower quadrant abdominal pain; (2) no symptoms of nausea or vomiting; (3) symptoms of constipation or diarrhea, and (4) abdominal pain for at least seven days. For patients in whom the diagnostic score exceeded two points, a contrast enhanced computed tomography (CT) scan of the abdomen was performed. Results Thirteen patients had a final diagnosis of RCD. These diagnostic criteria demonstrated a sensitivity of 85%, a specificity of 68%, a positive predictive value of 28%, a negative predictive value of 97%, and a diagnostic accuracy of 70%. Among the 38 patients examined with CT, diagnoses for acute diverticulitis included nine true positives, 26 true negatives, two false positives, and one false negative. Conclusion Performing CT scans after application of these diagnostic criteria gave a superior preoperative diagnostic rate for patients with RCD.