Skip to main content
SpringerLink
Log in

Radiology

  • Chapter
  • First Online:
Colonic Diverticular Disease

  • 634 Accesses

Abstract

Different scenarios embrace radiological imaging and colonic diverticula, including asymptomatic (diverticulosis) and symptomatic patients (acute diverticulitis, follow-up of acute diverticulitis, chronic diverticulitis). The role of imaging is in evolution; the role of computed tomography (CT) is validated and is widely supported by evidence in the case of acute diverticulitis, but this is not the case for acute diverticulitis follow-up or with symptoms related to diverticula without acute inflammation. In these settings, computed tomography colonography (CTC) is gaining consensus as the preferred radiological test.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Andeweg CS, Mulder IM, Felt-Bersma RJ, et al. Guidelines of diagnostics and treatment of acute left-sided colonic diverticulitis. Dig Surg. 2013;30:278–92.

    Article  CAS  PubMed  Google Scholar 

  2. Lameris W, van Randen A, Bipat S, et al. Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy. Eur Radiol. 2008;18:2498–511.

    Article  PubMed  Google Scholar 

  3. Liljegren G, Chabok A, Wickbom M, et al. Acute colonic diverticulitis: a systematic review of diagnostic accuracy. Colorectal Dis. 2007;9:480–8.

    Article  CAS  PubMed  Google Scholar 

  4. Fozard JB, Armitage NC, Schofield JB, et al. ACPGBI position statement on elective resection for diverticulitis. Color Dis. 2011;13(suppl 3):1–11.

    Article  Google Scholar 

  5. Nederlandse Vereniging voor Heelkunde. Richtlijn “Diagnostiek en behandeling acute diverticulitis van het colon” (Dutch Society of Surgery. Guideline “Diagnosis and Treatment of Acute Colonic Diverticulitis”). 2012. http://heelkunde.nl/uploads/mu/22/mu22HtlbEpr-SLLyAdT5nQ/NVvH-richtlijn-Acute-diverticulitis-van-het-colon-2012.pdf. Accessed June 2013.

  6. Schreyer AG, Layer G. S2k guidelines for diverticular disease and diverticulitis: diagnosis, classification, and therapy for the radiologist. Fortschr Röntgenstr. 2015;187:676–84.

    Article  CAS  Google Scholar 

  7. Schultz JK, Azhar N, Binda GA, et al. European Society of Coloproctology: guidelines for the management of diverticular disease of the colon. Color Dis. 2020;22(Suppl 2):5–28. https://doi.org/10.1111/codi.15140. Epub 2020 Jul 7

    Article  Google Scholar 

  8. Oh KY, Gilfeather M, Kennedy A, et al. Limited abdominal MRI in the evaluation of acute right upper quadrant pain. Abdom Imaging. 2003;28:643–51.

    Article  CAS  PubMed  Google Scholar 

  9. Heverhagen JT, Sitter H, Zielke A, et al. Prospective evaluation of the value of magnetic resonance imaging in suspected acute sigmoid diverticulitis. Dis Colon Rectum. 2008;51:1810–5.

    Article  PubMed  Google Scholar 

  10. Halligan S, Wooldrage K, Dadswell E, Kralj-Hans I, von Wagner C, et al. Computed tomographic colonography versus barium enema for diagnosis of colorectal cancer or large polyps in symptomatic patients (SIGGAR): a multicentre randomised trial. Lancet. 2013;381(9873):1185–93. https://doi.org/10.1016/S0140-6736(12)62124-2. Epub 2013 Feb 14

    Article  PubMed  Google Scholar 

  11. Neri E, Faggioni L, Cerri F, Turini F, Angeli S, et al. CT colonography versus double-contrast barium enema for screening of colorectal cancer: comparison of radiation burden. Abdom Imaging. 2010;35(5):596–601. https://doi.org/10.1007/s00261-009-9568-x. Epub 2009 Sep 24

    Article  PubMed  Google Scholar 

  12. Stevenson G. Colon imaging in radiology departments in 2008: goodbye to the routine double contrast barium enema. Can Assoc Radiol J. 2008;59(4):174–82.

    PubMed  Google Scholar 

  13. Jensen DM, Machicado GA, Jutabha R, et al. Urgent colonoscopy for the diagnosis and treatment of severe diverticular haemorrhage. N Engl J Med. 2000;342:78–82.

    Article  CAS  PubMed  Google Scholar 

  14. Bloomfeld RS, Rockey DC, Shetzline MA. Endoscopic therapy of an acute diverticula hemorrhage. Am J Gastroenterol. 2001;96:2367–72.

    Article  CAS  PubMed  Google Scholar 

  15. Smoot RL, Gostout CJ, Rajan E, et al. Is early colonoscopy after admission for acute diverticular bleeding needed? Am J Gastroenterol. 2003;98:1996–9.

    Article  PubMed  Google Scholar 

  16. Hizaya K, Miura N, Matsumoto T, Iida M. Colonic diverticular bleeding: precise localization and successful management by a combination of CT angiography and interventional radiology. Abdom Imaging. 2009;34:777–9.

    Article  Google Scholar 

  17. Loffroy R, Multidetector CT. Angiography for the detection of colonic diverticular bleeding: when, how, and why? Dig Dis Sci. 2013;58:1822–4.

    Article  PubMed  Google Scholar 

  18. Nagata N, Niikura R, Aoki T, Moriyasu S, Sakurai T, et al. Role of urgent contrast-enhanced multidetector computed tomography for acute lower gastrointestinal bleeding in patients undergoing early colonoscopy. J Gastroenterol. 2015;50:1162–72.

    Article  PubMed  Google Scholar 

  19. Barat M, Paisant A, Calame P, et al. Unenhanced CT for clinical triage of elderly patients presenting to the emergency department with acute abdominal pain. Diagn Interv Imaging. 2019;100:709–19.

    Article  CAS  PubMed  Google Scholar 

  20. Millet I, Sebbane M, Molinari N, et al. Systematic unenhanced CT for acute abdominal symptoms in th elderly patients improves both emergency deprtment diagnosis and prompt clinical management. Eur Radiol. 2017;27:868–77.

    Article  PubMed  Google Scholar 

  21. Expert panel on gastrointestinal imaging, Galgano SJ, MM MN, Peterson CM, et al. ACR appropriateness criteria left lower quadrant pain suspected diverticulitis. J Am Coll Radiol. 2019;16:S141–9.

    Article  Google Scholar 

  22. Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg. 1978;12:85–109.

    CAS  PubMed  Google Scholar 

  23. Klarenbeek BR, de Korte N, van der Peet DL, Cuesta MA. Review of current classifications for diverticular disease and a traslation into clinical practice. Int J Color Dis. 2012;27:207–14.

    Article  Google Scholar 

  24. Tursi A, Brandimarte G, Di Mario F, Andreoli A, Annunziata ML, et al. Development and validation of an endoscopic classification of diverticular disease of the colon: the DICA classification. Dig Dis. 2015;33(1):68–76. https://doi.org/10.1159/000366039. Epub 2014 Dec 17

    Article  PubMed  Google Scholar 

  25. Sartelli A, Moore FA, Ansaloni L, Di Saverio S, Coccolini F, et al. A proposal for a CT driven classification of left colon acute diverticulitis. World J Emerg Surg. 2015;10:3.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Ambrosetti P. Value of CT for acute left-colonic diverticulitis: the Surgeon’s view. Dig Dis. 2012;30:51–5.

    Article  PubMed  Google Scholar 

  27. Stoker J, van Randen A, Lameris W, Boermeester MA. Imaging patients with acute abdominal pain. Radiology. 2009;253:31–46.

    Article  PubMed  Google Scholar 

  28. van Randen A, Lameris W, Nio CY, et al. Inter-observer agreement for abdominal CT in unselected patients with acute abdominal pain. Eur Radiol. 2009;19:1394–407.

    Article  PubMed  Google Scholar 

  29. Chintapalli KN, Chopra S, Ghiatas AA, et al. Diverticulitis versus colon cancer: differentiation with helical CT findings. Radiology. 1999;210:429–35.

    Article  CAS  PubMed  Google Scholar 

  30. Shen SH, Chen JD, Tiu CM, et al. Differentiating colonic diverticulitis from colon cancer: the value of computed tomography in the emergency setting. J Chin Med Assoc. 2005;68:411–8.

    Article  PubMed  Google Scholar 

  31. Granlund J, Svensson T, Granath F, et al. Diverticular disease and the risk of colon cancer: a population based case-control study. Aliment Pharmacol Ther. 2011;34:675–81.

    Article  CAS  PubMed  Google Scholar 

  32. Huang WY, Lin CC, Jen YM, et al. Association between colonic diverticular disease and colorectal cancer: a nationwide population-based study. Clin Gastroenterol Hepatol. 2014;12:1288–94.

    Article  PubMed  Google Scholar 

  33. Flor N, Maconi G, Cornalba GP, Pickhardt PJ. The current role of radiologic and endoscopic imaging in diagnosis and foloow-up of colonic diverticular disease. AJR Am J Roentgenol. 2016;207:15–24.

    Article  PubMed  Google Scholar 

  34. Hjern F, Jonas E, Holmstrom B, Josephson T, Mellgren A, Johansson C. CT colonography versus colonoscopy in the follow-up of patients after diverticulitis. A prospective, comparative study. Clin Radiol. 2007;62:645–50.

    Article  CAS  PubMed  Google Scholar 

  35. De Cecco CN, Ciolina M, Annibale B, et al. Prevalence and distribution of colonic diverticula assessed with CT colonography. Eur Radiol. 2016;26(3):639–45. https://doi.org/10.1007/s00330-015-3866-1. Epub 2015 Jun 24

    Article  PubMed  Google Scholar 

  36. Gryspeerdt S, Lefere P. Chronic diverticulitis vs. colorectal cancer: findings on CT colonography. Abdom Imaging. 2012;37(6):1101–9. https://doi.org/10.1007/s00261-012-9858-6.

    Article  PubMed  Google Scholar 

  37. Lips LM, Cremers PT, Pickhardt PJ, Cremers SE, Janssen-Heijnen ML, de Witte MT, Simons PC. Sigmoid cancer versus chronic diverticular disease: differentiating features at CT colonography. Radiology. 2015;275(1):127–35. https://doi.org/10.1148/radiol.14132829. Epub 2014 Nov 26

    Article  PubMed  Google Scholar 

  38. Flor N, Rigamonti P, Di Leo G, et al. Technical quality of CT colonography in relation with diverticular disease. Eur J Radiol. 2012;81(3):e250–4.

    Article  PubMed  Google Scholar 

  39. Pichkardt PJ, Kim D. CT colonography. Pitfalls in interpretation. Radiol Clin N Am. 2013;51:69–88.

    Article  Google Scholar 

  40. Sanford M, Pickhardt PJ. Diagnostic performance of primary 3-dimensional computed tomography colonography in the setting of colonic diverticular disease. Clin Gastroenterol Hepatol. 2006;4:1039–47.

    Article  PubMed  Google Scholar 

  41. Flor N, Sardanelli F, Pickhardt PJ. Diagnostic accuracy of CT colonography for the detection of polyps in the diverticular disease. Scand J Gastroenterol. 2014;49(3):383–4.

    Article  PubMed  Google Scholar 

  42. Theranian S, Klinge M, Saul M, et al. Prevalence of colorectal cancer and advanced adenoma in patients with acute diverticulitis: implications for follow-up colonoscopy. Clin Endosc. 2020;91:634–40.

    Google Scholar 

  43. Flor N, Rigamonti P, Pisani Ceretti A, et al. Diverticular disease severity score based on CT colonography. Eur Radiol. 2013;23(10):2723–9.

    Article  PubMed  Google Scholar 

  44. Buchach CM, Kim DH, Pickhardt PJ. Performing an additional decubitus series at CT colonography. Abdom Imaging. 2011;36(5):538–44. https://doi.org/10.1007/s00261-010-9666-9.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Pickhardt PJ, Bakke J, Kuo J, Robbins JB, Lubner MG, del Rio AM, Kim DH. Volumetric analysis of colonic distention according to patient position at CT colonography: diagnostic value of the right lateral decubitus series. AJR Am J Roentgenol. 2014;203:W623–8.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Shinners TJ, Pickhardt PJ, Taylor AJ, Jones DA, Olsen CH. Patient-controlled room air insufflation versus automated carbon dioxide delivery for CT colonography. AJR Am J Roentgenol. 2006;186:1491–6.

    Article  PubMed  Google Scholar 

  47. Taylor SA, Halligan S, Goh V, Morley S, Bassett P, Atkin W, Bartram CI. Optimizing colonic distention for multi-detector row CT colonography: effect of hyoscine butylbromide and rectal balloon catheter. Radiology. 2003;229(1):99–108.

    Article  PubMed  Google Scholar 

  48. Köhler L, Sauerland S, Neugebauer R, et al. Diagnosis and treatment of diverticular disease. Results of a consensus development conference. Surg Endosc. 1999;13(4):430–6.

    Article  PubMed  Google Scholar 

  49. Flor N, Pickhardt PJ, Maconi G, et al. CT colonography followed by elective surgery in patients with acute diverticulitis: a radiological-pathological correlation study. Abdom Radiol (NY). 2021;46:491–7.

    Article  Google Scholar 

  50. Flor N, Maconi G, Sardanelli S, et al. Prognostic value of the diverticular disease severity score based on CT colonography: follow-up in patients recovering from acute diverticulitis. Acad Radiol. 2015;22:1503–9.

    Article  PubMed  Google Scholar 

  51. Hall J, Hardiman K, Lee S, et al. The american society of colon and rectal surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis. Dis Colon Rectum. 2020;63:728–47.

    Article  PubMed  Google Scholar 

  52. Sartelli A, Weber DG, Kluger Y, et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emer Surg. 2020;15:32.

    Article  Google Scholar 

  53. Francis NK, Sylla P, Abou-Khalil M, et al. EAES and SAGES 2018 consensus conference on acute diverticulitis management: evidence-based recommendations for clinical practice. Surg Endosc. 2019;33:2726–41.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Matsuki M, Okuda J, Kanazawa S, Kanamoto T, Inada Y, Tatsugami F, et al. Virtual CT colectomy by three-dimensional imaging using multidetector-row CT for laparoscopic colorectal surgery. Abdom Imaging. 2005;30:698–707.

    Article  CAS  PubMed  Google Scholar 

  55. Flor N, Campari A, Ravelli A, Lombardi MA, Pisani Ceretti A, et al. Vascular map combined with CT Colonography for evaluating candidates for laparoscopic colorectal surgery. Korean J Radiol. 2015;16:821–6.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Unità Operativa di Radiodiagnostica, Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco, Milan, Italy

    Nicola Flor

  2. Postgraduation School in Radiodiagnostic, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milan, Italy

    Silvia Innamorati

  3. Department of Radiology, School of Medicine & Public Health, University of Wisconsin, Madison, WI, USA

    Perry Pickhardt

Authors
  1. Nicola Flor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Silvia Innamorati
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Perry Pickhardt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nicola Flor .

Editor information

Editors and Affiliations

  1. Territorial Gastroenterology Service, Local Sanitary Agency Barletta-Andria-Trani, Barletta, Italy

    Antonio Tursi

  2. Department of Internal Medicine Division of Gastroenterology, Universidade Federal de Goiás, Goiânia, Brazil

    Mauro Bafutto

  3. Division of Internal Medicine and Gastroenterology, “Cristo Re” Hospital, Roma, Italy

    Giovanni Brandimarte

  4. Department of Surgery, Universidade Federal de Goiás School of Medicine, Goiânia, Brazil

    Enio Chaves de Oliveira

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Flor, N., Innamorati, S., Pickhardt, P. (2022). Radiology. In: Tursi, A., Bafutto, M., Brandimarte, G., Chaves de Oliveira, E. (eds) Colonic Diverticular Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-93761-4_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-93761-4_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-93760-7

  • Online ISBN: 978-3-030-93761-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation