[Computerized tomography in the study of acute sigmoid diverticulosis]

To report our experience in the study of acute left-sided colonic diverticulitis and to investigate the semiology and the possible diagnostic role of Computed Tomography (CT).

In the last 5 years, we examined with CT 52 patients with acute sigmoid diverticulitis. The examinations were performed with contiguous slices from the diaphragm to the perineum. An iodized contrast agent was administered orally in 32 cases and intravenously in 38. The diagnostic parameters we considered were: diverticula, pericolonic inflammation, thickening, intraparietal tracts, fistulas, pelvic phlegmons or abscesses, extrapelvic abscess or peritonitis, perforation, colonic obstruction, giant diverticula. Moreover, the cases were classified according to the system proposed by Neff in 5 stages.

In order of frequency, the CT findings included: pericolonic inflammatory infiltration (96% of the cases), parietal thickening (90.5%), diverticula (88.5%), pericolonic and intrapelvic abscessual collections (38.5% each), pericolonic phlegmon and colonic performation (11.5% each), extramural fistula (9.5%), stenosis with colonic obstruction (6%), intramural tract and extrapelvic abscess (4% each), giant diverticulum (2%). As for the severity of the inflammatory involvement, 15% of the cases were included in stage 0, 29% in I, 42.5% in II, 13.5% in III, and none in IV.

CT is an accurate diagnostic tool in the analysis of acute diverticulitis. Its main limitations are relative to the detection of early phases and the differentiation from carcinoma. CT should be performed to examine selected patients, with complicated diverticulitis.