Acute colonic diverticulitis: CT or ultrasound?

Excerpt

This issue offers two articles which point out the role of cross-sectional imaging for the management of patients with acute colonic diverticulitis (ACD) [1, 2]. Colonic diverticulosis affects approximately 5% of the population. Acute inflammation secondary to colonic diverticula occurring in 10–35% of these patients and increasing in frequency with advancing age, acute colonic diverticulitis is a common cause for acute abdominal symptoms, especially in the elderly. The clinical diagnosis and assessment of ACD can be difficult. The classic pattern of left lower quadrant pain with fever and elevated blood cell count can be mimicked by numerous acute abdominal conditions. Moreover, several studies has shown that fever and leukocytosis are poorly sensitive for the diagnosis of ACD, even when an abscess is associated [3, 4]. In these conditions, the patient’s management founded on the sole bioclinical approach can be inaccurate either by delaying the treatment of a severely complicated acute diverticulitis or by leading to surgery in patients who do not have any acute colonic inflammation; thus, the role of radiological evaluation of patients with suspected ACD is twofold: (a) to confirm the diagnosis and to distinguish patients with ACD from those with other acute abdominal condition accounting for their symptoms; and (b) to assess the site and the severity of the pericolic extension, with the aim of identifying patients less likely to respond to conservative treatment and in whom initial surgical treatment or percutaneous drainage must be considered. …