Computed tomography in the evaluation of diverticulitis

Area of Science:

• Radiology
• Gastroenterology
• Abdominal Imaging

Background:

• Colonic diverticulitis is a common condition requiring accurate diagnosis.
• Contrast-enema (CE) examination has been a traditional imaging tool.
• Limitations of CE in assessing disease extent and complications exist.

Purpose of the Study:

• To compare the diagnostic accuracy of computed tomography (CT) with contrast-enema (CE) for colonic diverticulitis.
• To evaluate the ability of CT to detect various complications of diverticulitis.
• To determine the optimal initial imaging modality for suspected diverticulitis.

Main Methods:

• Retrospective comparison of CT findings in 43 patients with colonic diverticulitis against CE findings in 37 patients.
• Detailed analysis of CT findings including pericolic fat inflammation, diverticula, wall thickening, abscesses, fistulas, obstruction, and sinus tracts.
• Assessment of secondary findings such as distant abscesses and ureteral obstruction.

Main Results:

• CT detected pericolic fat inflammation (98%), diverticula (84%), and colon wall thickening (70%).
• CT identified complications like pericolic abscess (35%), peritonitis (16%), fistula (14%), and obstruction (12%).
• CT revealed ureteral obstruction (7%) and distant abscesses (12%), with 41% of CE examinations underestimating pericolic inflammation.

Conclusions:

• CT is highly sensitive for detecting colonic diverticulitis and its complications, including pericolic inflammation, abscesses, and fistulas.
• CT provides a more comprehensive assessment of disease extent than CE, particularly regarding pericolic inflammation and secondary involvement.
• CT is recommended as the initial imaging procedure for suspected colonic diverticulitis, especially when CE is contraindicated.