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Computed tomography in the management of diverticulitis

Computed tomography evidence of a diverticular abscess has a prognostic impact and correlates with a high risk of failure from nonoperative management regardless of the patient's age, finds a recent study in American Journal of Gastroenterology.

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Acute diverticulitis is a disease with a wide clinical spectrum, ranging from a phlegmon (stage Ia), to localized abscesses (stages Ib and II), to free perforation with purulent (stage III) or feculent peritonitis (stage IV).

While there is little debate about the best treatment for mild episodes and/or very severe episodes, uncertainty persists about the optimal management for intermediate stages (Ib and II).

Dr Kaiser and colleagues defined the role of computed tomography and analyzed its impact on the management of acute diverticulitis.

The research team retrospectively analyzed 511 patients (296 males and 215 females) admitted for acute diverticulitis between 1994 and 2003.

The researchers excluded patients with stoma reversal only, "diverticulitis" mimicked by cancer, or significantly deficient patient records.

The investigators analyzed the patients either as a whole or subgroup according to age divided at 40 years.

The investigative team used a modified Hinchey classification to stage the severity of acute diverticulitis.

After treatment with computed tomography, elective surgery should be considered to prevent recurrent diverticulitis
American Journal of Gastroenterology

The team found an abscess in 99 patients, which in 74 was pericolic and 25 pelvic with a median diameter of 4 cm.

Computed tomography guided drainage was performed in 16 patients with 1 failure requiring a 2 stage operation.

Whereas conservative treatment failed in 7% in patients without abscess or perforation, the researchers reported that 22% of patients with an abscess required an urgent resection.

In addition; the team observed that recurrence rates were 13% for mild cases as compared to 41% in patients with a pelvic abscess (stage II) treated conservatively with/without computed tomography guided drainage.

Of all surgical cases, resection or primary anastomosis was achieved in 74% with perioperative mortality of 1% and a leak rate of 2%.

Dr Kaiser and team concluded; “Computed tomography evidence of a diverticular abscess has a prognostic impact as it correlates with a high risk of failure from nonoperative management regardless of the patient's age.”

“After treatment of diverticulitis with computed tomography evidence of an abscess, physicians should strongly consider elective surgery in order to prevent recurrent diverticulitis.”

Am J Gastroenterol 2005: 100(4): 910
31 March 2005

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