Surgical management in acute diverticulitis and its association with multi-detector CT, modified Hinchey classification, and clinical parameters
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To assess whether CT findings, clinical parameters, and modified Hinchey classification are predictive of management outcomes of patients with acute diverticulitis.
Materials and methods
Data were accrued between January 2014 and December 2015. A total of 301 adult subjects were identified from radiology reports, of which six who did not met the inclusion criteria were excluded, thus yielding 295 subjects. Subjects were 43.1% (n = 127) male and 56.9% female (n = 168), with mean age 51.9 years (range 18–90). Two independent abdominal radiologists reviewed all scans; imaging features and a modified Hinchey classification were scored. Descriptive statistics compared the relationships between imaging findings, clinical parameters obtained from medical record review, and modified Hinchey classification with management outcomes.
CT findings associated with surgical management include the presence of a pericolonic fluid collection (36.8% vs. 8.2%, P = 0.0001), colonic fistula (13.2% vs. 0.4%, P = 0.0002), extraluminal air (26.4% vs. 9.3%, P = 0.0052), bowel obstruction (5.2% vs. 0.0%, P = 0.0162), and a modified Hinchey score of Ib or higher (55.3% vs. 11.7%, P = 0.0001). Slightly lower systolic blood pressure was also associated with operative management (137.2 mmHg vs. 128.2 mmHg, P = 0.0220).
Specific CT imaging features and modified Hinchey classification are associated with subsequent surgical management in patients with acute diverticulitis.
KeywordsDiverticulitis Hinchey Abscess Management Colon Computed tomography
Special thanks to the Susanne Loomis and the REMS Media Services at Massachusetts General Hospital for assistance with the diagrams in this article.
Compliance with ethical standards
Conflict of interest
Dr. Bates declares that he has no conflict of interest. Dr. Bernal Fernandez declares that she has no conflict of interest. Dr. Ponchiardi declares that she has no conflict of interest. Dr. von Plato declares that he has no conflict of interest. Dr. Teich declares that he has no conflict of interest. Dr. Narsule declares that he has no conflict of interest. Dr. Anderson declares that he has no conflict of interest. Dr. Gupta declares that he has no conflict of interest. Dr. Lebedis declares that she has no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was waived by the institutional review board.
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