Impact of CT-Guided Drainage in the Treatment of Diverticular Abscesses: Size Matters

Siewert, Bettina; Tye, Grace; Kruskal, Jonathan B.; Sosna, Jacob; Opelka, Frank G.

doi:10.2214/ajr.04.1708

Cited by 218 publications

(126 citation statements)

References 27 publications

Supporting

Mentioning

113

Contrasting

Unclassified

Order By: Relevance

“…In the case of smaller abscesses that cannot be reliably punctured, daily inflammation monitoring and conservative therapy should be performed. According to the literature, abscesses can be detected on computed tomography in approximately 15 % of patients with acute diverticulitis [39,40]. In the case of larger abscesses > 4 cm, abscess drainage in combination with antibiotic therapy should be performed to prevent the need for emergency surgery.…”

mentioning

confidence: 99%

“…In the case of larger abscesses > 4 cm, abscess drainage in combination with antibiotic therapy should be performed to prevent the need for emergency surgery. Smaller abscesses less than 3 -4 cm can be cured in almost all cases by antibiotics alone [40]. There is a case control study in which the results for patients treated solely with antibiotic treatment in the case of abscesses that cannot be punctured were not inferior to the results of combined treatment via CT-guided drainage system plus antibiotics in the further clinical course [41].…”

mentioning

confidence: 99%

See 1 more Smart Citation

S2k Guidlines for Diverticular Disease and Diverticulitis: Diagnosis, Classification, and Therapy for the Radiologist

Schreyer

Layer

2015

Fortschr Röntgenstr

View full text Add to dashboard Cite

Diverticular disease and diverticulitis represent an increasingly common disease especially in patients with advanced age. The German Society of Digestive and Metabolic Diseases (DGVS) as well as the German Society of General and Visceral Surgery (DGAV) in collaboration with the German Radiology Society (DRG) created and published S2k guidelines regarding this topic. Knowledge of the diagnosis and therapy of this common disease is extremely important for the radiologist for the daily clinical routine. In this article we review and discuss the most important clinical situations and algorithms of this disease focusing on radiological topics. Additionally, we introduce the new CCD (classification of diverticular disease) system regarding radiology. Key Points: ??For the diagnosis of a diverticular disease a sectional imaging method should be performed. First choice should be a ?qualified ultrasound examination? followed by CT in uncertain situations or complicated disease. ??Disease classification should be done according the new CCD (Classification of diverticular disease) algorithm. ??Based on this new CCD patients can be stratified into outpatient, in-house patient and surgical treatment therapy. Citation Format: ??Schreyer AG, Layer G. S2k Guidlines for Diverticular Disease and Diverticulitis: Diagnosis, Classification, and Therapy for the Radiologist. Fortschr R?ntgenstr 2015; 187: 676???684

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

S2k Guidlines for Diverticular Disease and Diverticulitis: Diagnosis, Classification, and Therapy for the Radiologist

Schreyer

Layer

2015

Fortschr Röntgenstr

View full text Add to dashboard Cite

show abstract

“…2,3 Studies have shown that the incidence of an abscess complicating an episode of diverticulitis ranges from 17-19%. [4][5][6] The American Society of Colon and Rectal Surgeons recommended that small mesocolic abscesses can be treated with intravenous antibiotics. 7,8 In contrast, large abscesses may be drained percutaneously or by an open procedure.…”

mentioning

confidence: 99%

The Long-Term Results of Percutaneous Drainage of Diverticular Abscess

Singh

May

Coltart

et al. 2008

annals

View full text Add to dashboard Cite

INTRODUCTION Diverticulitis is a common condition occasionally complicated by abscess formation. Small abscesses may be managed by antibiotic therapy alone but larger collections require drainage, ideally by the percutaneous route. This minimally invasive approach is appealing but there is little information regarding the long-term follow-up of patients managed in this way. To address this question, we looked at a consecutive series of patients who underwent percutaneous drainage in our institution.PATIENTS AND METHODS A retrospective study was performed of patients undergoing percutaneous drainage of a diverticular abscess from 1999-2007. RESULTS A total of 26 abscesses were identified in 16 patients. In 69% of cases, the abscess was located in the pelvis. The mean size of the abscesses was 8.5 ±0 .9 cm. Drainage was performed under CT (83%) or ultrasound guidance. The mean duration of drainage was 8 days. Fistula formation following drainage occurred in 38% of cases. Eight patients (mean age, 71 years) underwent subsequent surgical resection 9 days to 22 months (mean, 7 months) following initial presentation. Eight patients with significant co-morbid conditions were managed by percutaneous drainage only. The 1-year mortality was 20% and resulted from unrelated causes. The long-term stoma rate was 13%.CONCLUSIONS Percutaneous drainage can safely be performed in patients with a diverticular abscess. It can be used as a bridge before definitive surgery but also as a treatment option in its own right in high-risk surgical patients. We believe percutaneous drainage reduces the need for major surgery and reduces the risk of a permanent stoma.

show abstract

“…This must be followed by referral for surgical treatment, if needed. The development of this technique allows avoiding multistage surgical procedures (14).…”

Section: Discussionmentioning

confidence: 99%

Excavated mass and double tracking in the sigmoid colon due to colocolic fistula complicating diverticulitis.

Pringot

et al. 2012

Journal of the Belgian Society of Radiology

View full text Add to dashboard Cite

Intramural abscesses/fistula complicating diverticulitis are uncommon (1, 2) and predominantly described in the sigmoid colon (3). On conventional radiology their appearance is described as having a double tract pattern (4).In a case of fistulous intramural abscess of the sigmoid colon, we report the CT and conventional radiographic features in correlation with histopathologic findings. Case reportA 72-year-old man with a history of prostatic adenocarcinoma classified as Gleason 8 presented a pelvic mass, different from prostate, on physical examination which justified further investigation. He complained of vague abdominal pain and a weight loss of 10 kg for the last 6 months. Several antibiotic therapies for various indications especially urinary symptoms were reported. No fever, no intestinal bleeding was reported.No significant change of the biological inflammatory parameters was found.Computer tomography (CT) of the abdomen showed narrowing of the sigmoid colon and an elongated paracolic soft-tissue mass (6.5 x 3 cm) containing gas and necrotic material as well as dense opacities. No adenopathy were found in the surrounding areas. A colonic excavated mass was suggested, the differential diagnosis including a perforated either primary or metastatic colonic neoplasm, but an invading vesical carcinoma was not excluded (Fig. 1). ple diverticula. It also demonstrated in this narrowed part crossing ridges, tethering of the inferior border and a normal mucosal appearance. A double track pattern was evenly showed, the second track being located along the inferior surface of the involved sigmoid with a indented superior and a regular inferior border. This 6 cm long sinus tract communicated with the true sigmoid lumen (Fig. 2). The Double contrast barium enema (DCBE), undertaken five days after, confirmed the narrowing of midsigmoid and the occurrence of multi-JBR-BTR, 2012, 95: 325-328. We report on a patient admitted for work up of prostatic carcinoma in which CT study showed an excavated mass involving the sigmoid colon and the bladder dome. Barium enema showed a double track pattern associated with diverticular disease. By surgery the mass was separated from the urinary bladder and the sigmoid resected. On pathological exam diverticulitis was evident as well as an organised colocolic fistula in the thickened fibrotic subserosal fat. The usefulness of opacifying the colon is highlighted. EXCAVATED MASS AND DOUBLE TRACKING IN THE SIGMOID COLON DUE TO COLOCOLIC FISTULA COMPLICATING DIVERTICULITIS

show abstract

Impact of CT-Guided Drainage in the Treatment of Diverticular Abscesses: Size Matters

Cited by 218 publications

References 27 publications

S2k Guidlines for Diverticular Disease and Diverticulitis: Diagnosis, Classification, and Therapy for the Radiologist

S2k Guidlines for Diverticular Disease and Diverticulitis: Diagnosis, Classification, and Therapy for the Radiologist

The Long-Term Results of Percutaneous Drainage of Diverticular Abscess

Excavated mass and double tracking in the sigmoid colon due to colocolic fistula complicating diverticulitis.

Contact Info

Product

Resources

About