[Colonic diverticulitis. Primary clinical and ultrasound diagnosis--report of 47 cases from general practice]

Clinical and sonographic diagnosis-Report on 47 cases From 1993 to 1996, 47 patients with/after acute diverticulitis were examined in our practice by abdominal ultrasound. In all 36 cases with acute diverticulitis, a dolent non-echous wall thickening of descendent/sigmoid colon was seen. In five cases, we found other sonographic signs suspicious of penetration. Elevation of CRP and sometimes leukocytosis assisted the diagnosis in acute cases. In 39 of the 47 patients, colonoscopy was performed in the practice mostly during intermissions. Diverticula were confirmed in 31 patients whereas sigmoid stenosis from chronic diverticulitis could not be passed in 6 cases. 32 patients were treated with antibiotics and 10-including those with stenosis-underwent surgery. Except in one particular case (tubar abscess involving the sigmoid), operation confirmed sonographic findings of severe inflammation (stenosis and sealed perforation, respectively, in five cases). In patients presenting with pain in the left lower quadrant of the abdomen, colonic diverticulitis has to be considered especially if signs of inflammation are present. After clinical examination the first diagnostic measures should be venopuncture (CRP, leukocytes) and at the same time abdominal ultrasound by an experienced clinician. Due to its high accuracy, abdominal ultrasound is sufficient for primary diagnosis and evaluation of the course of colonic diverticulitis. Colonoscopy and barium enema follow after resolution of acute inflammation.