Advertisement

World Journal of Surgery

, Volume 38, Issue 7, pp 1814–1818 | Cite as

The Limited Role of Ultrasound in the Diagnostic Process of Colonic Diverticulitis

  • K. NielsenEmail author
  • M. C. Richir
  • T. T. Stolk
  • T. van der Ploeg
  • G. R. H. M. Moormann
  • B. M. Wiarda
  • W. H. Schreurs
Article
  • 342 Downloads

Abstract

Background

Diverticulitis is commonly diagnosed using ultrasound (US), followed by computed tomography (CT). Our aim was to determine the diagnostic accuracy of US compared with CT for patients with uncomplicated and complicated diverticulitis.

Methods

We reviewed medical records of 232 patients admitted with diverticulitis via the emergency department between January 2009 and January 2011. Patients who had undergone US and a CT scan were identified and further analyzed.

Results

A total of 123 patients underwent an US and a CT scan. In 78/94 patients with uncomplicated diverticulitis, results of US and CT scan were compatible (83 %); in 6 of the remaining 29 patients both modalities showed a complicated diverticulitis (21 %). US misdiagnosed 17 % of patients with uncomplicated diverticulitis and 79 % with complicated diverticulitis.

Conclusions

US is insufficient for diagnosing a complicated diverticulitis. Missing a complicated diverticulitis can have important clinical implications, and if diverticulitis is suspected, we suggest obtaining a CT scan to confirm diagnosis and to exclude complications.

Keywords

Compute Tomography Diverticulitis Diverticular Disease Complicated Diverticulitis Complicated Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

No funding/grants or conflicts of interest to report.

References

  1. 1.
    Stollman N, Raskin JB (2004) Diverticular disease of the colon. Lancet 363:631–639PubMedCrossRefGoogle Scholar
  2. 2.
    Janes SEJ, Meagher A, Frizelle FA (2006) Management of diverticulitis. BMJ 332:271–275PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Andeweg CS, Knobben L, Hendriks JCM et al (2011) How to diagnose acute left-sided colonic diverticulitis: proposal for a clinical scoring system. Ann Surg 253:940–946PubMedCrossRefGoogle Scholar
  4. 4.
    Laméris W, van Randen A, van Gulik TM et al (2010) A clinical decision rule to establish the diagnosis of acute diverticulitis at the emergency department. Dis Colon Rectum 53:896–904PubMedCrossRefGoogle Scholar
  5. 5.
    Diagnostiek en behandeling acute diverticulitis van het colon (2010) http://www.mdl.nl/uploads/240/996/NVvH-richtlijn_acute-diverticulitis-van-het-colon_2010.pdf. Accessed 29 Dec 2012
  6. 6.
    Destigter KK, Keating DP (2009) Imaging update: acute colonic diverticulitis. Clin Colon Rectal Surg 22:147–155PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Laméris W, van Randen A, Bipat S et al (2008) Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy. Eur Radiol 18:2498–2511PubMedCrossRefGoogle Scholar
  8. 8.
    Hinchey EJ, Schaal PG, Richards GK (1978) Treatment of perforated diverticular disease of the colon. Adv Surg 12:85–109PubMedGoogle Scholar
  9. 9.
    Balfe DM, Levine MS, Ralls PW et al (2000) Evaluation of left lower quadrant pain. American College of Radiology. ACR Appropriateness Criteria. Radiology 215 Suppl:167–171PubMedGoogle Scholar
  10. 10.
    Farag Soliman M, Wustner M, Sturm J et al (2004) Primary diagnostics of acute diverticulitis of the sigmoid. Ultraschall Med 25:342–347PubMedCrossRefGoogle Scholar
  11. 11.
    Laméris W, van Randen A, van Es HW et al (2009) Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. BMJ 338:b2431PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Rao PM, Rhea JT, Novelline RA et al (1998) Helical CT with only colonic contrast material for diagnosing diverticulitis: prospective evaluation of 150 patients. AJR Am J Roentgenol 170:1445–1449PubMedCrossRefGoogle Scholar
  13. 13.
    Pradel JA, Adell JF, Taourel P et al (1997) Acute colonic diverticulitis: prospective comparative evaluation with US and CT. Radiology 205:503–512PubMedCrossRefGoogle Scholar
  14. 14.
    Toorenvliet BR, Bakker RFR, Breslau PJ et al (2010) Colonic diverticulitis: a prospective analysis of diagnostic accuracy and clinical decision-making. Colorectal Dis 12:179–186PubMedCrossRefGoogle Scholar
  15. 15.
    van Randen A, Laméris W, van Es HW et al (2011) A comparison of the accuracy of ultrasound and computed tomography in common diagnoses causing acute abdominal pain. Eur Radiol 21:1535–1545PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Eggesbø HB, Jacobsen T, Kolmannskog F et al (1998) Diagnosis of acute left-sided colonic diverticulitis by three radiological modalities. Acta Radiol 39:315–321PubMedCrossRefGoogle Scholar
  17. 17.
    Hollerweger A, Macheiner P, Rettenbacher T et al (2001) Colonic diverticulitis: diagnostic value and appearance of inflamed diverticula—sonographic evaluation. Eur Radiol 11:1956–1963PubMedCrossRefGoogle Scholar
  18. 18.
    Kaser SA, Fankhauser G, Glauser PM et al (2010) Diagnostic value of inflammation markers in predicting perforation in acute sigmoid diverticulitis. World J Surg 34:2717–2722. doi: 10.1007/s00268-010-0726-7 PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • K. Nielsen
    • 1
    Email author
  • M. C. Richir
    • 1
  • T. T. Stolk
    • 1
  • T. van der Ploeg
    • 2
  • G. R. H. M. Moormann
    • 1
  • B. M. Wiarda
    • 3
  • W. H. Schreurs
    • 1
  1. 1.Department of SurgeryMedical Centre AlkmaarAlkmaarThe Netherlands
  2. 2.Department of Clinical EpidemiologyMedical Centre AlkmaarAlkmaarThe Netherlands
  3. 3.Department of RadiologyMedical Centre AlkmaarAlkmaarThe Netherlands

Personalised recommendations