Early use of CT in the management of acute diverticulitis of the colon

• Published in: Revista española de enfermedades digestivas Vol. 99; no. 6; pp. 320 - 324
• Main Authors: Martín Arévalo, J, García-Granero, E, García Botello, S, Muñoz, E, Cervera, V, Flor Lorente, B, Lledó, S
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.06.2007
• Subjects: Acute Disease; Adult; Aged; Barium Sulfate; Diagnosis, Differential; Disease Management; Diverticulitis, Colonic - complications; Diverticulitis, Colonic - diagnostic imaging; Diverticulitis, Colonic - surgery; Early Diagnosis; Female; Humans; Male; Middle Aged; Peritonitis - etiology; Predictive Value of Tests; Prospective Studies; Severity of Illness Index; Tomography, X-Ray Computed; Unnecessary Procedures
• ISSN: 1130-0108

To assess the early use of CT for the diagnosis, staging, and management of acute diverticulitis. A prospective study of 102 patients with a clinical diagnosis of acute diverticulitis of the left colon. Acute diverticulitis was initially divided into 3 clinical stages. Patients were restaged according to CT findings into stages I, IIa, IIb, and III. Diagnosis was subsequently confirmed intraoperatively or by colonoscopy or barium studies. 102 patients (52 females and 50 males, mean age of 59.4 (SD + 14.96 years)) were included; 84 (82.35%) patients with a clinical diagnosis of acute diverticulitis were confirmed to suffer this disease for a diagnostic error of 17.65% (n=18). Acute diverticulitis was diagnosed by CT in 84.3% (n=86). CT had a sensitivity of 100% and a specificity of 88.9%. CT changed clinical stage for 38% of patients because of understaging in 13% and of overstaging in 25%. When stages II and III were analyzed separately, 60 and 50% were overstaged, respectively. The reclassification of patients according to CT results had a significant impact on treatment. Early clinical staging with CT avoids diagnostic clinical errors in 17.65% of patients. CT changes the initial clinical staging of acute episodes in 38% of cases, thus avoiding unnecessary delays in surgery for severe cases, and unnecessary surgeries for mild cases.