Surgeon-performed ultrasound for the staging of acute diverticulitis: Preliminary results of a prospective study

Abstract

Although contrast-enhanced abdominal computed tomography (CEACT) is still considered the criterion standard for the assessment of suspected acute diverticulitis, in recent years, the use of point-of-care ultrasound (POCUS) has been spreading more and more in this setting. The aim of this study was to compare CEACT to POCUS for the diagnosis and staging of suspected acute diverticulitis. METHODS:This is a prospective study conducted on 55 patients admitted to the emergency department of two Italian Hospitals with a clinical suspicion of acute diverticulitis between January 2014 and December 2017. All the patients included underwent POCUS first and CEACT immediately afterward, with the diagnosis and the staging reported according to the Hinchey (H) classification modified by Wasvary et al.[Wasvary H, Turfah F, Kadro O, Beauregard W. Same hospitalization resection for acute diverticulitis. Am Surg. 1999;65:632-635.] Three surgeons performed all the POCUS, and the same two radiologists retrospectively analyzed all the CEACT images. The radiologists were informed of the clinical suspicion but unaware of the POCUS findings. The CEACTwas used as the criterion standard for the comparison. RESULTS:The final cohort included 30 females (55%) and 25 males (45%). The median age was 62 years (range, 24-88 years), and the median body mass index was 26 kg/m 2 (range, 19-42 kg/m 2 ). Forty-six of 55 patients had a confirmed diagnosis of acute diverticulitis on both POCUS and CEACT, whereas, in 7 patients, the diagnosis was not confirmed by both methods. Point-of-care ultrasound sensitivity and specificity were 98% and 88%, respectively. Point-of-care ultrasound positive and negative predictive values were 98% and 88%, respectively. Point-of-care ultrasound accuracy was 96%. Point-of-care ultrasound classified 33 H1a, 11 H1b, 1 H2, and 1 H3 acute diverticulitis. This staging was confirmed in all patients but three (93%) by CEACT. CONCLUSION:Point-of-care ultrasound appeared a reliable technique for the diagnosis and the staging of clinically suspected H1 and H2 acute diverticulitis. It could contribute in saving time and resources and in avoiding unnecessary radiation exposure to most patients.

Surgeon-Performed Point-of-Care Ultrasound in the Diagnosis of Acute Sigmoid Diverticulitis: A Pragmatic Prospective Multicenter Cohort Study

“…Although 25% of our patients were misclassified on POCUS the clinical outcome was unaffected in these early stages of uncomplicated diverticulitis (1a and 1b) as fluid resuscitation, bowel rest, pain relief, antibiotics, and antiinflammatory medications were indicated regardless of which early Hinchey stage [38]. A recent study by Zago et al found that POCUS correctly identified the Hinchey classification in 93% of acute diverticulitis cases [30].…”

“…This could be explained by the small study size as other studies, with larger sample sizes, reported specificities of approximately 90% [14,28,29]. Specific features such as thickening of the bowel wall, pericolic fat changes, and pain on graded compression were the main findings on sonography described in other studies making these the key features [15,28,[30][31][32][33][34]. Along with these essential elements, other findings such as diverticula, and the absence of peristalsis or abscesses aided in the classification of severity as reported by others [35,36].…”

Current diagnosis and management of acute colonic diverticulitis: What you need to know

“…15,16,38 Surgeon-performed US has been shown to have sensitivity of 98% and specificity of 88%; positive and negative predictive values of US were 98% and 88%, respectively. 38 While US has some utility in diagnosis, a negative or inconclusive US should always prompt CT imaging where available. 38 Plain radiographic films of the abdomen are not useful for diagnosis of acute colonic diverticulitis but may be helpful to assess for complications such as perforation or bowel obstruction.…”

“…38 While US has some utility in diagnosis, a negative or inconclusive US should always prompt CT imaging where available. 38 Plain radiographic films of the abdomen are not useful for diagnosis of acute colonic diverticulitis but may be helpful to assess for complications such as perforation or bowel obstruction. 16 Figure 2 highlights the approach to initial evaluation, diagnosis, and management of acute colonic diverticulitis.…”

Accuracy of “TICS” ultrasound protocol in detecting simple and complicated diverticulitis: A prospective cohort study

“…The US has been shown to narrow the differential diagnosis, expedite clinical management, and reduce the cost of care 10–13 . Collectively, these results suggest that US may have a role in the ED diagnosis and management of diverticulitis, given the high accuracy and potential to expedite patient care; however, barriers to implementation include distinguishing between simple and complicated diseases by sonography and must be further explored 10–13 . Should a more dependable and reproducible sonography protocol and specific US characteristics suggestive of complications be defined?…”