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How complicated is complicated diverticulitis?—phlegmonous diverticulitis revisited

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study is to elucidate the accuracy of a clinical classification system for acute diverticulitis with special regard to “phlegmonous diverticulitis”.

Methods

A consecutive patient series (n = 318; General Hospital Nuremberg, 1/2004–12/2006) was classified preoperatively (imaging with 4/16-slice spiral CT scanner) according to the Hansen and Stock (H&S) classification which is commonly used in Germany and evaluated based on histopathology.

Results

Pre-treatment classification grouped 30 patients (9.4%) as uncomplicated diverticulitis (type I according to H&S), for whom treatment was merely conservative. One hundred twelve patients (35.2%) were classified as phlegmonous diverticulitis (type IIA), 84 (26.4%) as “covered perforations” (type IIB) and 27 (8.5%) as “free perforations” (type IIC), and 54 (17.0%) as chronically recurrent diverticulitis (type III, 17.0%). The remaining 11 patients (3.5%) were not staged preoperatively. Accuracy of staging of complicated diverticulitis differed significantly between type IIC (100.0%), type IIB (91.0%), and type IIA (36.1%). The latter group was frequently understaged as it concealed a substantial number of patients (n = 44; 53.0%) with IIB disease. Neither laboratory tests (CRP/WBC) nor clinical parameters allowed distinction of correctly and falsely staged patients with type IIA disease.

Conclusions

Patients with phlegmonous diverticulitis (type IIA) represent the most challenging group among patients with acute diverticulitis as they are frequently understaged and conceal cases with covered perforations (type IIB). This may support the view to subsume phlegmonous diverticulitis (type IIA) under complicated diverticulitis.

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Abbreviations

CT:

Computed tomography

n.a.:

Not applicable

H.E.:

Hematoxylin–eosin

H&S:

Hansen and Stock

SD:

Standard deviation

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Authors and Affiliations

  1. Department of General-, Visceral-, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany

    Christian F. Jurowich, Christoph Isbert, Christoph-Thomas Germer & Burkhard H. A. von Rahden

  2. Department of General-, Visceral- and Thoracic Surgery, General Hospital Nuremberg, Nuremberg, Germany

    Christian F. Jurowich, Stefanie Jellouschek, Christoph Isbert & Christoph-Thomas Germer

  3. Department of Radiology, General Hospital Nuremberg, Nuremberg, Germany

    Ralf Adamus & Reinhard Loose

  4. Department of Pathology, General Hospital Nuremberg, Nuremberg, Germany

    Annette Kaiser

  5. Klinik und Poliklinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie (Chirurgische Klinik I), Universitätsklinikum Würzburg, Zentrum für operative Medizin (ZOM), Oberdürrbacherstr. 6, 97080, Würzburg, Germany

    Burkhard H. A. von Rahden

Authors
  1. Christian F. Jurowich
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  2. Stefanie Jellouschek
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  3. Ralf Adamus
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  4. Reinhard Loose
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  5. Annette Kaiser
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  6. Christoph Isbert
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  7. Christoph-Thomas Germer
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  8. Burkhard H. A. von Rahden
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Corresponding author

Correspondence to Burkhard H. A. von Rahden.

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Jurowich, C.F., Jellouschek, S., Adamus, R. et al. How complicated is complicated diverticulitis?—phlegmonous diverticulitis revisited. Int J Colorectal Dis 26, 1609–1617 (2011). https://doi.org/10.1007/s00384-011-1280-y

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  • DOI: https://doi.org/10.1007/s00384-011-1280-y

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