Preoperative CT staging in sigmoid diverticulitis—does it correlate with intraoperative and histological findings?

Ritz, Jörg‐Peter; Lehmann, Kai S.; Loddenkemper, Christoph; Frericks, Bernd; Buhr, H. J.; Holmer, Christoph

doi:10.1007/s00423-010-0609-2

Cited by 46 publications

(45 citation statements)

References 18 publications

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“…Laméris et al [53] tested the prospective studies using the QUADAS tool. The sensitivity for US and CT was comparable [92% (CI 80-97) vs. 94% (CI 87-97)], as was the specificity [90% (CI 82-95) vs. 99% (CI 95-100)] [54]. …”

Section: History-taking Basic Diagnostic Procedures Differential DImentioning

confidence: 99%

“…The reliability in abscess-forming stages (HS IIb, Hinchey I/II) was 92% (surgical findings) and 90% (histology) with understaging of 3 and 0%, respectively, and overstaging in 5 and 10%. Free perforation (HS IIc, Hinchey 3/4) was correctly identified in 100%, so that the PPV of CT for HS IIa, HS IIb and HS IIc was 52 and 56%, 92 and 90% and 100 and 100% [54]. …”

Section: History-taking Basic Diagnostic Procedures Differential DImentioning

confidence: 99%

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Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Kruis

Germer²,

Leifeld³

et al. 2014

Digestion

134

117

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Background: Diverticular disease is one of the most common disorders of the gastrointestinal tract. 28-45% of the population develop colonic diverticula, while about 25% suffer symptoms and about 5% complications. Aim: To create formal guidelines for diagnosis and management. Methods: Six working groups with 44 participants analyzed key questions in subject areas assigned to them. Following a systematic literature search, 451 publications were included. Consensus was obtained by agreement within the working groups, two Delphi processes and a guideline conference. Results: Targeted management of diverticular disease requires a classificatory diagnosis. A new classification was created. In addition to the clinical examination, intestinal ultrasound or computed tomography is the determining factor. Interval colonoscopy is recommended to exclude comorbidities. A low-fiber diet, obesity, lack of exercise, smoking and immunosuppression have an adverse impact on diverticulosis. This can lead to diverticulitis. Antibiotics are no longer recommended in uncomplicated diverticulitis if no risk factors such as immunosuppression are present. If close monitoring is ensured, uncomplicated diverticulitis can be treated on an outpatient basis. Complicated diverticulitis should be treated in hospital, involving broad-spectrum antibiotic therapy, where necessary abscess drainage, and surgery, if possible laparoscopically. In the case of chronic relapsing diverticulitis, the risk of perforation decreases with each episode, so that surgery is no longer recommended after the second episode but only following individual assessment. Conclusions: New findings on diverticular disease call into question the overuse of antibiotics and excessive indications for surgery. Targeted treatment requires a precise diagnosis and intensive interdisciplinary cooperation. i 2014 S. Karger AG, Basel

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Section: History-taking Basic Diagnostic Procedures Differential DImentioning

confidence: 99%

Section: History-taking Basic Diagnostic Procedures Differential DImentioning

confidence: 99%

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Kruis

Germer²,

Leifeld³

et al. 2014

Digestion

134

117

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“…2). Allgemein wird unter dem Stadium I nach Hansen und Stock eine auf die Kolonwand beschränkte, nicht wandüberschreitende Entzündung der Divertikel verstanden [19,31,32]. In der Regel wird zur Abgrenzung von der wandüberschreitenden Entzündung bzw.…”

Section: Akute Unkomplizierte Divertikulitis (Aud)unclassified

“…Bei der AUD ist in der CT entweder kein pathologischer Befund zu erheben oder eine umschriebene Wandverdickung zu erkennen. Ritz et al [32] weisen jedoch darauf hin, dass die CT im Stadium IIa nach Hansen und Stock, also der wandüberschreitenden Entzündung, in bis zu einem Drittel der Fälle zum Overstaging verglichen mit dem intraoperativen und histologischen Befund führt.…”

Section: Akute Unkomplizierte Divertikulitis (Aud)unclassified

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Diagnostik und Klassifikation der Divertikelkrankheit

Böhm¹

2012

Viszeralmedizin

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Die Divertikelkrankeit ist eine der bedeutsamsten Erkrankungen in der Gastroenterologie; gleichzeitig sind viele Aspekte des ärztlichen Handelns, insbesondere auch der Therapie, im Bereich dieses Krankheitsbildes nur durch wenig Evidenz abgesichert. Fortschritte in der Therapie hängen generell stark von der exakten Diagnostik und Klassifikation eines Krankheitsbildes ab. Daher wurde der aktuelle Stand der Diagnostik und der Stadieneinteilung mittels einer Abfrage der Literatur-Datenbank von Pubmed untersucht. Das Leitsymptom der Divertikelkrankheit – «linksseitige Unterbauchbeschwerden» – erlaubt vielfältige Differenzialdiagnosen, während es der klinischen Evaluation inklusive Laboruntersuchungen an diagnostischer Trennschärfe gegenüber anderen Krankheitsbildern mangelt. Laborparameter erlauben keine zuverlässige Differenzierung zwischen akuter unkomplizierter (AUD) und akuter komplizierter Divertikulitis (ACD). Lediglich die symptomatische unkomplizierte Divertikelkrankheit (SUDD) lässt sich nach Tursi durch das Fehlen von erhöhten Routinelaborparametern abgrenzen. Sowohl für die Differenzialdiagnose als auch für die Klassifikation der Divertikelkrankheit ist somit die Bildgebung unabdingbar. Die CT hat sich gegenüber dem Ultraschall in der täglichen Praxis als Referenzmethode durchgesetzt. Die Endoskopie besitzt ihren Hauptstellenwert in der postakuten Phase zur Bestätigung der Diagnose und zum Ausschluss alternativer Diagnosen, insbesondere des Kolonkarzinoms. Publikationen der jüngeren Zeit weisen auf die Notwendigkeit einer neuen Klassifikation der Divertikelkrankheit hin. Die Evaluation neuer therapeutischer Strategien, die sich für die Therapie der Divertikelkrankheit abzeichnen, erfordert eine exakte Klassifikation der Krankheitsstadien. Aufgabe der Diagnostik ist es, die Stadien mit einer ausreichend hohen Trennschärfe zu differenzieren.

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Performance of Ultrasonography in the Diagnosis of Acute Colonic Diverticulitis

Perysinakis,

Klontzas,

Psaroudakis

et al. 2023

J of Ultrasound Medicine

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ObjectivesComputed tomography is regarded as the reference‐standard imaging modality for the assessment of acute left‐sided colonic diverticulitis (ALCD). However, its utility may be impaired by cost issues, limited availability, radiation exposure, and contrast‐related adverse effects. Ultrasonography is increasingly advocated as an alternative technique for evaluating ALCD, although there is variation regarding its accuracy in disease diagnosis and staging and in determining alternative diagnoses. The aim of this study was to assess the performance of ultrasonography in diagnosing ALCD, differentiating complicated from non‐complicated disease and defining alternative diseases related to left lower quadrant pain.MethodsWithin a 2‐year period, all consecutive adult patients with clinically suspected ALCD and available abdominal computed tomography were prospectively evaluated and planned to undergo an abdominal ultrasonographic examination, tailored to the assessment of left lower quadrant. Computed tomography (CT) was regarded as the reference standard.ResultsA total of 132 patients (60 males, 72 females; mean age: 61.3 ± 11 years) were included. The sensitivity, specificity, and area under curve of ultrasonography for diagnosing ALCD were 88.6, 84.9, and 86.8%, with positive and negative predictive values of 89.7 and 83.3%, respectively. The method had sensitivity, specificity, and area under curve of 77.8, 100, and 88.9%, respectively, for defining complicated disease. The area under the curve for the identification of alternative diseases in patients with left lower quadrant pain was 90.9%.ConclusionsUltrasonography has high diagnostic accuracy for diagnosing ALCD, differentiating complicated from non‐complicated disease and establishing alternative diagnoses related to left lower quadrant pain. A low threshold to get a CT should be maintained as not to miss cases that may mimic ALCD.

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Preoperative CT staging in sigmoid diverticulitis—does it correlate with intraoperative and histological findings?

Cited by 46 publications

References 18 publications

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Diagnostik und Klassifikation der Divertikelkrankheit

Performance of Ultrasonography in the Diagnosis of Acute Colonic Diverticulitis

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