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CT imaging for prediction of complications and recurrence in acute uncomplicated diverticulitis
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
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2016 (English)In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 31, no 2, p. 451-457Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The first randomized clinical trial of antibiotics in uncomplicated diverticulitis (the AVOD study) showed no benefit of antibiotics. The aim of this study was to re-evaluate the computed tomography (CT) scans of the patients in the AVOD study to find out whether there were CT findings that were missed and to study whether CT signs in uncomplicated diverticulitis could predict complications or recurrence.

METHODS: The CT scan images from patients included in the AVOD study were re-evaluated and graded by two independent reviewers for different signs of diverticulitis, including complications, such as extraluminal gas or the presence of an abscess.

RESULTS: Of the 623 patients included in the study, 602 CT scans were obtained and re-evaluated. Forty-four (7 %) patients were found to have complications on the admitting CT scan that had been overlooked. Twenty-seven had extraluminal gas and 17 had an abscess. Four of these patients deteriorated and required surgery, but the remaining patients improved without complications. Of the 18 patients in the no-antibiotic group, in whom signs of complications on CT were overlooked, 15 recovered without antibiotics. No CT findings in patients with uncomplicated diverticulitis could predict complications or recurrence.

CONCLUSION: No CT findings that could predict complications or recurrence were found. A weakness in the initial assessment of the CT scans to detect extraluminal gas and abscess was found but, despite this, the majority of patients recovered without antibiotics. This further supports the non-antibiotic strategy in uncomplicated diverticulitis.

Place, publisher, year, edition, pages
2016. Vol. 31, no 2, p. 451-457
Keywords [en]
Colonic diverticulitis; Complications; CT scan; Prediction
National Category
Gastroenterology and Hepatology Surgery
Identifiers
URN: urn:nbn:se:uu:diva-269592DOI: 10.1007/s00384-015-2423-3ISI: 000369537500034PubMedID: 26490053OAI: oai:DiVA.org:uu-269592DiVA, id: diva2:883429
Available from: 2015-12-17 Created: 2015-12-17 Last updated: 2018-08-03Bibliographically approved
In thesis
1. Acute Colonic Diverticulitis: The role of computed tomography in primary diagnosis, prediction of complications and surgical intervention
Open this publication in new window or tab >>Acute Colonic Diverticulitis: The role of computed tomography in primary diagnosis, prediction of complications and surgical intervention
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to expand the current knowledge regarding the advantages and limitations of computed tomography (CT) for patients with acute diverticulitis and evaluate outpatient treatment for uncomplicated diverticulitis.

Paper I: A retrospective evaluation of 602 patients with reported uncomplicated diverticulitis. Scans were re-evaluated and the degree of inflammation was graded. Signs of complications or other diseases were also noted. No radiological findings on CT could predict the development of complications or recurrence in patients with uncomplicated diverticulitis. However, 44 patients (7.3%) had signs of complicated diverticulitis that had been overlooked on the initial assessment. Despite small complications and a non-antibiotic treatment, the majority of patients recovered without incident, further strengthening the non-antibiotic treatment strategy.

Paper II: A retrospective analysis of conservative treatment for perforated diverticulitis (n = 136) during a 5-year period. Twenty-nine of 136 patients were operated on within 24 h and not candidates for conservative management. Patients more than 75 years old, immunosuppressed patients, patients with free intraperitoneal air or free fluid in the abdominal cavity were at higher risk for emergency surgery within the first 24 h. Conservative treatment was successful in 101 of 107 patients (94%) when attempted. The presence of simultaneous abscess increased the risk for conservative treatment failure.

Paper III: The aim of this prospective study was to determine if a non-enhanced low-dose CT was as sensitive as standard CT with intravenous (IV) contrast for patients with suspected acute diverticulitis. The included patients underwent both types of CT examinations. CT images were graded by three independent radiologists for the presence of diverticulitis, complications or other findings that could explain the patient’s symptoms. Sensitivity, specificity and both intra- and inter-reader agreement for low-dose CT were very high. Therefore, we recommend this examination for suspected diverticulitis.

Paper IV: In this prospective study, 155 consecutive patients with CT-verified acute uncomplicated diverticulitis were treated as outpatients without antibiotics. Overall, only four patients (2.6%) returned to the hospital because of treatment failure, all of whom were hospitalized and received antibiotics. Outpatient treatment of uncomplicated diverticulitis is safe and recommended in selected patients.

 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 65
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1483
Keywords
Colonic diverticulitis, complicated diverticulitis, computed tomography, low-dose CT
National Category
Medical and Health Sciences
Research subject
Radiology; Surgery
Identifiers
urn:nbn:se:uu:diva-356710 (URN)978-91-513-0397-0 (ISBN)
Public defence
2018-09-28, Aulan, entrance 21,, Västmanlands Hospital, Västerås, 13:15 (English)
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Supervisors
Available from: 2018-09-05 Created: 2018-08-03 Last updated: 2018-09-10

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Thorisson, ArnarSmedh, KennetPåhlman, LarsChabok, Abbas

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