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[Acute left-sided colonic diverticulitis: diagnosis and surgical indications after successful conservative therapy of first time acute diverticulitis].
Zentralbl Chir. 1998; 123(12):1382-5.ZC

Abstract

PURPOSE

To compare the performances of computed tomography (CT) and water soluble contrast enema in the diagnosis and evaluation of the severity of acute left colonic diverticulitis, and to propose indications for elective colectomy after a first episode of diverticulitis successfully treated medically.

PATIENTS AND METHODS

Prospective non-randomized study (1986-1997) of 542 patients (290 women and 252 men with a median age of 64 years) whose final diagnosis was confirmed either histologically or radiologically. 465 patients (86%) had a CT, 439 (81%) had a water soluble contrast enema, and 420 (77%) had both examinations. Diverticulitis was considered moderate when CT showed localized thickening of colonic wall (> or = 5 mm) and inflammation of pericolic fat and water soluble contrast enema showed segmental lumen narrowing and tattered mucosa; it was considered severe when abscess and/or extraluminal air/or extraluminal contrast were described by CT or the two latter by water soluble contrast enema.

RESULTS

410 patients (76%) were treated medically and 132 were operated during their hospitalization. Sensitivity of CT for diagnosis of diverticulitis was 96%, compared to 87% for water soluble contrast enema (p < 0.0001). Severe diverticulitis was found in 139 patients (30%) by CT and in 45 patients (11%) by water soluble contrast enema (p < 0.0001). Age < or = 50 years, severe diverticulitis in the initial CT and associated pelvic abscess were found to be statistically significant parameters to predict the risk of secondary complications after a first episode of diverticulitis successfully treated medically.

CONCLUSIONS

Performances of CT for diagnosis and evaluation of severity of acute diverticulitis are statistically higher than that of water soluble contrast enema. We would recommend elective colectomy in patients 50 years of age or younger with a severe diverticulitis in initial CT, and in all patients with an associated pelvic abscess.

Authors+Show Affiliations

Clinic of Digestive Surgery, University Hospital of Geneva, Switzerland.No affiliation info available

Pub Type(s)

Journal Article

Language

ger

PubMed ID

10063549

Citation

Ambrosetti, P, and P Morel. "[Acute Left-sided Colonic Diverticulitis: Diagnosis and Surgical Indications After Successful Conservative Therapy of First Time Acute Diverticulitis]." Zentralblatt Fur Chirurgie, vol. 123, no. 12, 1998, pp. 1382-5.
Ambrosetti P, Morel P. [Acute left-sided colonic diverticulitis: diagnosis and surgical indications after successful conservative therapy of first time acute diverticulitis]. Zentralbl Chir. 1998;123(12):1382-5.
Ambrosetti, P., & Morel, P. (1998). [Acute left-sided colonic diverticulitis: diagnosis and surgical indications after successful conservative therapy of first time acute diverticulitis]. Zentralblatt Fur Chirurgie, 123(12), 1382-5.
Ambrosetti P, Morel P. [Acute Left-sided Colonic Diverticulitis: Diagnosis and Surgical Indications After Successful Conservative Therapy of First Time Acute Diverticulitis]. Zentralbl Chir. 1998;123(12):1382-5. PubMed PMID: 10063549.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Acute left-sided colonic diverticulitis: diagnosis and surgical indications after successful conservative therapy of first time acute diverticulitis]. AU - Ambrosetti,P, AU - Morel,P, PY - 1999/3/4/pubmed PY - 1999/3/4/medline PY - 1999/3/4/entrez SP - 1382 EP - 5 JF - Zentralblatt fur Chirurgie JO - Zentralbl Chir VL - 123 IS - 12 N2 - PURPOSE: To compare the performances of computed tomography (CT) and water soluble contrast enema in the diagnosis and evaluation of the severity of acute left colonic diverticulitis, and to propose indications for elective colectomy after a first episode of diverticulitis successfully treated medically. PATIENTS AND METHODS: Prospective non-randomized study (1986-1997) of 542 patients (290 women and 252 men with a median age of 64 years) whose final diagnosis was confirmed either histologically or radiologically. 465 patients (86%) had a CT, 439 (81%) had a water soluble contrast enema, and 420 (77%) had both examinations. Diverticulitis was considered moderate when CT showed localized thickening of colonic wall (> or = 5 mm) and inflammation of pericolic fat and water soluble contrast enema showed segmental lumen narrowing and tattered mucosa; it was considered severe when abscess and/or extraluminal air/or extraluminal contrast were described by CT or the two latter by water soluble contrast enema. RESULTS: 410 patients (76%) were treated medically and 132 were operated during their hospitalization. Sensitivity of CT for diagnosis of diverticulitis was 96%, compared to 87% for water soluble contrast enema (p < 0.0001). Severe diverticulitis was found in 139 patients (30%) by CT and in 45 patients (11%) by water soluble contrast enema (p < 0.0001). Age < or = 50 years, severe diverticulitis in the initial CT and associated pelvic abscess were found to be statistically significant parameters to predict the risk of secondary complications after a first episode of diverticulitis successfully treated medically. CONCLUSIONS: Performances of CT for diagnosis and evaluation of severity of acute diverticulitis are statistically higher than that of water soluble contrast enema. We would recommend elective colectomy in patients 50 years of age or younger with a severe diverticulitis in initial CT, and in all patients with an associated pelvic abscess. SN - 0044-409X UR - https://www.unboundmedicine.com/medline/citation/10063549/[Acute_left_sided_colonic_diverticulitis:_diagnosis_and_surgical_indications_after_successful_conservative_therapy_of_first_time_acute_diverticulitis]_ L2 - http://www.diseaseinfosearch.org/result/9681 DB - PRIME DP - Unbound Medicine ER -