A proposal for a CT driven classification of left colon acute diverticulitis

Abstract

Computed tomography (CT) imaging is the most appropriate diagnostic tool to confirm suspected left colonic diverticulitis. However, the utility of CT imaging goes beyond accurate diagnosis of diverticulitis; the grade of severity on CT imaging may drive treatment planning of patients presenting with acute diverticulitis.The appropriate management of left colon acute diverticulitis remains still debated because of the vast spectrum of clinical presentations and different approaches to treatment proposed. The authors present a new simple classification system based on both CT scan results driving decisions making management of acute diverticulitis that may be universally accepted for day to day practice.

IPOD Study: Management of Acute Left Colonic Diverticulitis in Italian Surgical Departments

“…Staging according to WSES classification [2] was requested for all patients undergoing CT scan at admission:…”

“…It does include a variety of conditions, ranging from localized diverticular inflammation to fecal peritonitis. It is usually classified in uncomplicated and complicated according to the extension of the infection process to the peritoneum [2].…”

The Multidisciplinary Management of Acute Complicated Diverticulitis

“…For each of these stages, clinical characteristics, radiological findings, and treatment modalities are given [14]. More recently, Sartelli et al [15] have proposed a CT-based classification, with suggested management options, to drive decision-making in nonoperative and operative treatment of ACD. Nevertheless, currently, the modified Hinchey classification (Fig.…”

“…Initial choice of antibiotic regimen should be empirical and therefore partly depends on presumable pathogens involved, as well as local resistance profiles and other risk factors for resistance patterns [29]. Additional CT imaging is advised in patients with persistent signs of intra-abdominal infection after 4–6 days, or in case of recurrent evidence of infection [15]. Although the reported results seem to indicate that nonoperative management is a viable option, even in patients with extraluminal air, a careful case-by-case decision should still be made, with attention to the patient’s clinical state [30, 31].…”

Three‐trocar colectomy for perforated diverticulitis – a video vignette

“…Dear Editor, Colonic diverticulosis is a common condition in modern society due to nutritional habits and lifestyle [1]. Treatment of acute diverticulitis varies from conservative treatment to colonic resection according to the severity of the inflammation, which is usually determined with clinical presentation and imaging findings [2]. The disease recurs in about 20% of patients.…”