Acute diverticulitis of the cecum and ascending colon: thin-section helical CT findings.

Jang, Hyun‐Jung; Lim, H. K.; Lee, Soon Jin; Choi, Sang Hee; Lee, Min Hee; Choi, Moon Hae

doi:10.2214/ajr.172.3.10063843

Cited by 63 publications

(70 citation statements)

References 14 publications

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“…The isolated finding of colonic wall thickening appears to be associated with colon cancer, which may be a mimicker of diverticulitis (32-36). Although colonic wall thickening by itself is nonspecific, many authors have validated findings that accurately point to a diagnosis of diverticulitis, including inflamed diverticula, pericolic fat stranding, fluid at the mesentery, and a preserved bowel enhancement pattern (37)(38)(39)(40). With use of these criteria, the overall accuracy of CT for the diagnosis of acute in 20 of 117 patients-three of whom received a diagnosis of colon cancer at surgery.…”

Section: Evidence-based Practice: Colonoscopy After Ct Diagnosis Of Dmentioning

confidence: 99%

“…We opted for using data from the U.S census, which has been used in other research projects (57)(58)(59) and is considered the official population number. In addition, we chose to use the Surveillance Epidemiology and End Results database to estimate the colon cancer prevalence because it is one of the most reliable cancer registries in the United States and because of the diverticulitis has been shown to be approximately 99% (22,39). Thus, the definitions of what constitutes diverticulitis versus colon cancer at CT may have affected the prevalence of colon cancer in published studies.…”

Section: Evidence-based Practice: Colonoscopy After Ct Diagnosis Of Dmentioning

confidence: 99%

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Colonoscopy after CT Diagnosis of Diverticulitis to Exclude Colon Cancer: A Systematic Literature Review

Sai¹,

Velayos²,

Neuhaus³

et al. 2012

Radiology

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Purpose:To estimate the prevalence of underlying adenocarcinoma of the colon in patients in whom acute diverticulitis was diagnosed at computed tomography (CT) and to compare that to the prevalence of colon cancer in the general population. Materials and Methods:A comprehensive literature review was performed to find articles in which patients with CT diagnosis of acute diverticulitis underwent surgery, colonoscopy, or barium enema study within 24 weeks. Patients meeting these criteria were included for analysis. A pooled prevalence of cancer was calculated on the basis of a random effects model and compared qualitatively with the prevalence of cancer in the general population. The 95% confidence intervals around the prevalence of cancer in the study populations were determined. Results:Ten articles met the inclusion criteria. Data from these articles included only 771 patients who underwent surgery, colonoscopy, or barium enema study within 24 weeks of diagnosis. Fourteen patients were found to have colon cancer, for a prevalence of 2.1% (95% confidence interval: 1.2%, 3.2%). This compares to a calculated estimated prevalence of 0.68% among U.S. adults older than 55 years.

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Section: Evidence-based Practice: Colonoscopy After Ct Diagnosis Of Dmentioning

confidence: 99%

Section: Evidence-based Practice: Colonoscopy After Ct Diagnosis Of Dmentioning

confidence: 99%

Colonoscopy after CT Diagnosis of Diverticulitis to Exclude Colon Cancer: A Systematic Literature Review

Sai¹,

Velayos²,

Neuhaus³

et al. 2012

Radiology

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show abstract

“…Much of this information is based on case series data, which have relatively small sample sizes and the preoperative diagnosis was not made using imaging studies. Recent studies suggest that colonic diverticulitis can be correctly diagnosed by computed tomography (CT) scan [6,7,10] , or ultrasonography (US) [11][12][13][14] , and with the use of these imaging studies, right colonic diverticulitis is more common than has been previously assumed [7] . The aim of this study was to evaluate the clinical course and results of medical therapy in patients with right colonic diverticulitis, of which the final diagnosis was based on radiographic evidence from CT or US, or operative findings.…”

Section: Introductionmentioning

confidence: 99%

Image-guided conservative management of right colonicdiverticulitis

Park¹,

Choi²,

Lee³

et al. 2009

WJG

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AIM:To study the clinical outcomes of medical therapy in patients with right colonic diverticulitis. METHODS:The records of 189 patients with right colonic diverticulitis which was finally diagnosed by computed tomography, ultrasonography, or operative findings were retrospectively reviewed. RESULTS:Of the 189 patients hospitalized for right colonic diverticulitis, the stages of diverticulitis by a modified Hinchey classification were 26 patients (13.8%) in stage 0, 139 patients (73.5%) in stage Ⅰ a, 23 patients (12.2%) in stage Ⅰb, and 1 patient (0.5%) in stage Ⅲ. Medical therapy was undertaken in 185 of 189 patients (97.9%). One hundred and eighty three of 185 patients were successfully treated with bowel rest and antibiotics. Two patients in stage Ⅰb required a resection or surgical drainage because of an inadequate response to conservative treatment. Recurrent diverticulitis developed in 15 of 183 patients (8.2%) who responded to medical therapy. All 15 patients who suffered a second attack had uncomplicated diverticulitis, and were successfully treated with medical therapy. CONCLUSION:Our results indicate that right colonic diverticulitis is essentially benign and image-guided conservative treatment is primarily required.

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“…In our case, CT indicated diverticulum without abscess formation in the caecal wall. In patients with preoperative di-agnosis of cecal diverticulitis without signs of peritonitis, medical treatment with antibiotics may be sufficient (4). There is no standard surgical procedure for the treatment of inflamed solitary caecal diverticulum.…”

mentioning

confidence: 99%

Caecal diverticulitis mimicking acute appendicitis

Buluş¹,

Koyuncu²,

Taş³

et al. 2013

Turk J Gastroenterol

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Solitary caecal diverticulitis is a rare cause of abdominal pain in Western patients and is more common in the Oriental population (1). In this paper, we describe a patient who was thought to have acute appendicitis or pelvic inflammatory disease preoperatively. At operation, inflamed solitary caecal diverticulum was detected.A 56-year-old man was admitted to our hospital with two-day history of abdominal pain in the right lower quadrant. He had no nausea or vomiting. His past medical history was unremarkable. Physical examination revealed a temperature of 37.8°C, heart rate -80 beats/min, and blood pressure of 128/75 mmHg. Physical examination was unremarkable other than right iliac fossa tenderness and rebound. Rectal digital examination was normal. Apart from the increase in WBC to 12.9 and CRP to 42, laboratory investigations including urinalysis were within normal limits. Computed tomography (CT) scan showed a tumor in the cecum surrounded by inflammatory plate (Figure 1). At operation, there was a small amount of clear free fluid. The appendix was normal, as was the terminal ileum. There was a solitary diverticulum projecting from the medial aspect of the caecum and forming an inflammatory mass with the omentum (Figure 2). Diverticulectomy and incidental appendectomy were performed. His postoperative course was uneventful, and he was discharged home after a week of admission.The true prevalence of colonic diverticulosis is difficult to ascertain, however, it appears that about 8.5% of people in Western countries are afflicted (2). In Western countries, 85% of all diverticula occur in the descending and sigmoid colon. The reported frequency of caecal diverticulum in the literature has been estimated to be 1 in 300 appendicectomies (3). Nausea and vomiting are less frequent, abdominal pain typically starts and remains in the right iliac fossa rather than beginning in the central abdomen and shifting to the right iliac fossa. Right iliac fossa tenderness is not usually as marked as in acute appendicitis. Intravenous contrast-enhanced CT scanning can accurately demonstrate the features of acute right-sided diverticulitis (4). The features of caecal diverticulum include colonic wall thickening, pericolic fat infiltration, associated abscess formation, and extraluminal air denoting perforation. In our case, CT indicated diverticulum without abscess formation in the caecal wall. In patients with preoperative di-

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Acute diverticulitis of the cecum and ascending colon: thin-section helical CT findings.

Cited by 63 publications

References 14 publications

Colonoscopy after CT Diagnosis of Diverticulitis to Exclude Colon Cancer: A Systematic Literature Review

Colonoscopy after CT Diagnosis of Diverticulitis to Exclude Colon Cancer: A Systematic Literature Review

Image-guided conservative management of right colonicdiverticulitis

Caecal diverticulitis mimicking acute appendicitis

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