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  • 1.
    Isacson, Daniel
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Vastmanlands Hosp Vasteras, Colorectal Unit, Dept Surg, SE-72189 Vasteras, Sweden..
    Thorisson, Arnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Vastmanlands Hosp Vasteras, Dept Radiol, SE-72189 Vasteras, Sweden..
    Andreasson, K.
    Vastmanlands Hosp Vasteras, Colorectal Unit, Dept Surg, SE-72189 Vasteras, Sweden..
    Nikberg, Maziar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Vastmanlands Hosp Vasteras, Colorectal Unit, Dept Surg, SE-72189 Vasteras, Sweden..
    Smedh, Kennet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Vastmanlands Hosp Vasteras, Colorectal Unit, Dept Surg, SE-72189 Vasteras, Sweden..
    Chabok, Abbas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Vastmanlands Hosp Vasteras, Colorectal Unit, Dept Surg, SE-72189 Vasteras, Sweden..
    Outpatient, non-antibiotic management in acute uncomplicated diverticulitis: a prospective study2015In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 30, no 9, p. 1229-1234Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate outpatient, non-antibiotic management in acute uncomplicated diverticulitis with regard to admissions, complications, and recurrences, within a 3-month follow-up period. A prospective, observational study in which patients with computer tomography-verified acute uncomplicated diverticulitis were managed as outpatients without antibiotics. The patients kept a personal journal, were contacted daily by a nurse, and then followed up by a surgeon at 1 week and 3 months. In total, 155 patients were included, of which 54 were men; the mean age of the patients was 57.4 years. At the time of diagnosis, the mean C-reactive protein and white blood cell count were 73 mg/l and 10.5 x 10(9), respectively, and normalized in the vast majority of patients within the first week. The majority of the patients (97.4 %) were managed successfully as outpatients without antibiotics, admissions, or complications. In only four (2.6 %) patients, the management failed because of complications in three and deterioration in one. These patients were all treated successfully as inpatients without surgery. Five patients had recurrences and were treated as outpatients without antibiotics. Follow-up colonic investigations revealed cancer in two patients and polyps in 13 patients. Previous results of low complication rates with the non-antibiotic policy were confirmed. The new policy of outpatient management without antibiotics in acute uncomplicated diverticulitis is now shown to be feasible, well functioning, and safe.

  • 2.
    Isacson, Daniel
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Västmanland´s Hospital.
    Thorisson, Arnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Västmanland´s Hospital.
    Andreasson, Karl
    Nikberg, Maziar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Västmanland´s Hospital.
    Smedh, Kennet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Västmanland´s hospital.
    Chabok, Abbas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Västmanland´s hospital.
    Outpatient, non-antibiotic management in acute uncomplicated diverticulitis: a prospective study2015In: International Journal of Colorectal Disease, Vol. 30, no 9, p. 1229-1234Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    The aim of this study was to evaluate outpatient, non-antibiotic management in acute uncomplicated diverticulitis with regard to admissions, complications, and recurrences, within a 3-month follow-up period.

    METHODS:

    A prospective, observational study in which patients with computer tomography-verified acute uncomplicated diverticulitis were managed as outpatients without antibiotics. The patients kept a personal journal, were contacted daily by a nurse, and then followed up by a surgeon at 1 week and 3 months.

    RESULTS:

    In total, 155 patients were included, of which 54 were men; the mean age of the patients was 57.4 years. At the time of diagnosis, the mean C-reactive protein and white blood cell count were 73 mg/l and 10.5 × 10(9), respectively, and normalized in the vast majority of patients within the first week. The majority of the patients (97.4%) were managed successfully as outpatients without antibiotics, admissions, or complications. In only four (2.6%) patients, the management failed because of complications in three and deterioration in one. These patients were all treated successfully as inpatients without surgery. Five patients had recurrences and were treated as outpatients without antibiotics. Follow-up colonic investigations revealed cancer in two patients and polyps in 13 patients.

    CONCLUSION:

    Previous results of low complication rates with the non-antibiotic policy were confirmed. The new policy of outpatient management without antibiotics in acute uncomplicated diverticulitis is now shown to be feasible, well functioning, and safe.

  • 3.
    Thorisson, Arnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Acute Colonic Diverticulitis: The role of computed tomography in primary diagnosis, prediction of complications and surgical intervention2018Doctoral 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.

     

    List of papers
    1. CT imaging for prediction of complications and recurrence in acute uncomplicated diverticulitis
    Open this publication in new window or tab >>CT imaging for prediction of complications and recurrence in acute uncomplicated diverticulitis
    Show others...
    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.

    Keywords
    Colonic diverticulitis; Complications; CT scan; Prediction
    National Category
    Gastroenterology and Hepatology Surgery
    Identifiers
    urn:nbn:se:uu:diva-269592 (URN)10.1007/s00384-015-2423-3 (DOI)000369537500034 ()26490053 (PubMedID)
    Available from: 2015-12-17 Created: 2015-12-17 Last updated: 2018-08-03Bibliographically approved
    2. Non-operativemanagement of perforated diverticulitis with extraluminal or free air
    Open this publication in new window or tab >>Non-operativemanagement of perforated diverticulitis with extraluminal or free air
    Show others...
    (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708Article in journal (Other academic) Submitted
    Abstract [en]

    Objectives The aim of this study was to describe characteristics and results of non-operative   management for patients presenting with computed tomography (CT) verified perforated diverticulitis.

    Methods All patients treated for diverticulitis (ICD-10: K-57) during 2010–2014 were identified and medical records were reviewed. Re-evaluations of CT examinations for all patients with complicated disease according to medical records were performed. All patients diagnosed with perforated diverticulitis on re-evaluation were included and characteristics of patients having immediate surgery and those whom non-operative management was attempted are described.

    Results Of 141 patients with perforated diverticulitis according to medical records, 136 were confirmed on CT re-evaluation. Emergency surgical intervention within 24 hours was performed in 29 (21%). Non-operative management with iv antibiotics was attempted for 107 patients and was successful in 101 (94%). The 30-day mortality rate was 2%. Non-operative management was more likely to fail in patients with a simultaneous abscess (67% compared to 16%, p = 0.013). More than one third of patients (34%) with free air were successfully managed conservatively. Patients that were operated within 24 hours from admission were more commonly on immunosuppressive therapy, had more commonly free intraperitoneal air and free fluid in the peritoneal cavity.

    Conclusions Non-operative management is successful in the majority of patients with CT-verified perforated diverticulitis with extraluminal air, and also in one-third of those with free air in the peritoneal cavity.

    National Category
    Medical and Health Sciences
    Research subject
    Radiology; Surgery
    Identifiers
    urn:nbn:se:uu:diva-356629 (URN)
    Available from: 2018-08-02 Created: 2018-08-02 Last updated: 2018-08-03Bibliographically approved
    3. Diagnostic Accuracy of Acute Diverticulitis with Non-Enhanced Low-Dose CT
    Open this publication in new window or tab >>Diagnostic Accuracy of Acute Diverticulitis with Non-Enhanced Low-Dose CT
    Show others...
    2018 (English)In: Article in journal (Other academic) Submitted
    Abstract [en]

    Purpose: To evaluate the diagnostic accuracy of non-enhanced low-dose computed tomography (LDCT) in acute colonic diverticulitis with contrast-enhanced standard-dose CT (SDCT) as the reference method.

    Materials and Methods: Consecutive patients with clinically suspected diverticulitis were included from two hospitals between January and October 2017. All patients underwent LDCT followed by SDCT. All CT examinations were assessed for signs of diverticulitis, complications, and other diagnoses by three independent radiologists (two radiology consultants and one fourth-year resident) using SDCT as the reference method. Sensitivity, specificity, and agreement were calculated.

    Results: In total, 149 patients (median age 68, 107 women) were included; 107 had diverticulitis on standard CT. Sensitivity for diverticulitis using LDCT was 100%; the values were 99% for consulting radiologists and 92% for the radiology resident. Specificity was 100% for both consultants and 84% for the resident. Sensitivity for identification of complications was 74%, 60%, and 54%, respectively. Twenty-six patients had other causes of abdominal symptoms on standard CT, 23 (88%) of whom were diagnosed correctly on LDCT. One case of splenic infarction and two cases of segment colitis were missed on LDCT.

    Conclusion: The diagnostic accuracy of LDCT was high for acute diverticulitis. Therefore, it is recommended as a standard method that should help to reduce radiation dose and cost. LDCT had lower sensitivity for complications, although discrimination between an inflamed diverticulum and small pericolic abscess accounted for a proportion of the discrepancies.

    National Category
    Medical and Health Sciences Radiology, Nuclear Medicine and Medical Imaging
    Research subject
    Radiology; Surgery
    Identifiers
    urn:nbn:se:uu:diva-356709 (URN)
    Available from: 2018-08-03 Created: 2018-08-03 Last updated: 2018-08-06Bibliographically approved
    4. Outpatient, non-antibiotic management in acute uncomplicated diverticulitis: a prospective study
    Open this publication in new window or tab >>Outpatient, non-antibiotic management in acute uncomplicated diverticulitis: a prospective study
    Show others...
    2015 (English)In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 30, no 9, p. 1229-1234Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to evaluate outpatient, non-antibiotic management in acute uncomplicated diverticulitis with regard to admissions, complications, and recurrences, within a 3-month follow-up period. A prospective, observational study in which patients with computer tomography-verified acute uncomplicated diverticulitis were managed as outpatients without antibiotics. The patients kept a personal journal, were contacted daily by a nurse, and then followed up by a surgeon at 1 week and 3 months. In total, 155 patients were included, of which 54 were men; the mean age of the patients was 57.4 years. At the time of diagnosis, the mean C-reactive protein and white blood cell count were 73 mg/l and 10.5 x 10(9), respectively, and normalized in the vast majority of patients within the first week. The majority of the patients (97.4 %) were managed successfully as outpatients without antibiotics, admissions, or complications. In only four (2.6 %) patients, the management failed because of complications in three and deterioration in one. These patients were all treated successfully as inpatients without surgery. Five patients had recurrences and were treated as outpatients without antibiotics. Follow-up colonic investigations revealed cancer in two patients and polyps in 13 patients. Previous results of low complication rates with the non-antibiotic policy were confirmed. The new policy of outpatient management without antibiotics in acute uncomplicated diverticulitis is now shown to be feasible, well functioning, and safe.

    Keywords
    Diverticulitis, Outpatient management, Antibiotics
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy Clinical Medicine
    Identifiers
    urn:nbn:se:uu:diva-262965 (URN)10.1007/s00384-015-2258-y (DOI)000360542000011 ()25989930 (PubMedID)
    Note

    Correction in: International Journal of Colorectal Disease, 2015, vol. 30, issue 9, pages 1225-1235, doi: 10.1007/s00384-015-2284-9

    Available from: 2015-09-24 Created: 2015-09-23 Last updated: 2018-12-10Bibliographically approved
  • 4.
    Thorisson, Arnar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Västmanland Hosp Västerås, Dept Radiol, Västerås, Sweden.
    Hosseinali Khani, Maziar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Västmanland Hosp Västeras, Dept Surg, Colorectal Unit, Västeras, Sweden.
    Andreasson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Västmanland Hosp Västeras, Dept Surg, Colorectal Unit, Västeras, Sweden.
    Smedh, Kennet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Västmanland Hosp Västeras, Dept Surg, Colorectal Unit, Västeras, Sweden.
    Chabok, Abbas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Västmanland Hosp Västeras, Dept Surg, Colorectal Unit, Västeras, Sweden.
    Non-operative management of perforated diverticulitis with extraluminal or free air - a retrospective single center cohort study2018In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 53, no 10-11, p. 1298-1303Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to describe patient characteristics and results of non-operative management for patients presenting with computed tomography (CT) verified perforated diverticulitis with extraluminal or free air.

    Methods: All patients treated for diverticulitis (ICD-10: K-57) during 2010–2014 were identified and medical records were reviewed. Re-evaluations of CT examinations for all patients with complicated disease according to medical records were performed. All patients diagnosed with perforated diverticulitis and extraluminal or free air on re-evaluation were included and characteristics of patients having immediate surgery and those whom non-operative management was attempted are described.

    Results: Of 141 patients with perforated diverticulitis according to medical records, 136 were confirmed on CT re-evaluation. Emergency surgical intervention within 24 h of admission was performed in 29 (21%) patients. Non-operative management with iv antibiotics was attempted for 107 patients and was successful in 101 (94%). The 30-day mortality rate was 2%. The presence of a simultaneous abscess was higher for patients with failure of non-operative management compared with those that were successfully managed non-operatively (67% compared to 17%, p = .013). Eleven out of thirty-two patients (34%) with free air were successfully managed conservatively. Patients that were operated within 24 h from admission were more commonly on immunosuppressive therapy, had more commonly free intraperitoneal air and free fluid in the peritoneal cavity.

    Conclusions: Non-operative management is successful in the majority of patients with CT-verified perforated diverticulitis with extraluminal air, and also in one-third of those with free air in the peritoneal cavity.

  • 5.
    Thorisson, Arnar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Västmanlands Hospital.
    Nikberg, Maziar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Västmanlands Hospital.
    Andreasson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Västmanlands Hospital.
    Smedh, Kennet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Västmanlands Hospital.
    Chabok, Abbas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Västmanlands Hospital.
    Non-operativemanagement of perforated diverticulitis with extraluminal or free airIn: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708Article in journal (Other academic)
    Abstract [en]

    Objectives The aim of this study was to describe characteristics and results of non-operative   management for patients presenting with computed tomography (CT) verified perforated diverticulitis.

    Methods All patients treated for diverticulitis (ICD-10: K-57) during 2010–2014 were identified and medical records were reviewed. Re-evaluations of CT examinations for all patients with complicated disease according to medical records were performed. All patients diagnosed with perforated diverticulitis on re-evaluation were included and characteristics of patients having immediate surgery and those whom non-operative management was attempted are described.

    Results Of 141 patients with perforated diverticulitis according to medical records, 136 were confirmed on CT re-evaluation. Emergency surgical intervention within 24 hours was performed in 29 (21%). Non-operative management with iv antibiotics was attempted for 107 patients and was successful in 101 (94%). The 30-day mortality rate was 2%. Non-operative management was more likely to fail in patients with a simultaneous abscess (67% compared to 16%, p = 0.013). More than one third of patients (34%) with free air were successfully managed conservatively. Patients that were operated within 24 hours from admission were more commonly on immunosuppressive therapy, had more commonly free intraperitoneal air and free fluid in the peritoneal cavity.

    Conclusions Non-operative management is successful in the majority of patients with CT-verified perforated diverticulitis with extraluminal air, and also in one-third of those with free air in the peritoneal cavity.

  • 6.
    Thorisson, Arnar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Department of Radiology, Västmanlands Hospital, Västerås, Sweden..
    Nikberg, Maziar
    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.
    Torkzad, Michael R
    Department of Diagnostic Radiology, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK.
    Laurell, Helena
    Colorectal Unit, Department of Surgery, Landstinget Dalarna, Mora, Sweden..
    Smedh, Kennet
    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.
    Chabok, Abbas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Diagnostic Accuracy of Acute Diverticulitis with Non-Enhanced Low-Dose CT2018In: Article in journal (Other academic)
    Abstract [en]

    Purpose: To evaluate the diagnostic accuracy of non-enhanced low-dose computed tomography (LDCT) in acute colonic diverticulitis with contrast-enhanced standard-dose CT (SDCT) as the reference method.

    Materials and Methods: Consecutive patients with clinically suspected diverticulitis were included from two hospitals between January and October 2017. All patients underwent LDCT followed by SDCT. All CT examinations were assessed for signs of diverticulitis, complications, and other diagnoses by three independent radiologists (two radiology consultants and one fourth-year resident) using SDCT as the reference method. Sensitivity, specificity, and agreement were calculated.

    Results: In total, 149 patients (median age 68, 107 women) were included; 107 had diverticulitis on standard CT. Sensitivity for diverticulitis using LDCT was 100%; the values were 99% for consulting radiologists and 92% for the radiology resident. Specificity was 100% for both consultants and 84% for the resident. Sensitivity for identification of complications was 74%, 60%, and 54%, respectively. Twenty-six patients had other causes of abdominal symptoms on standard CT, 23 (88%) of whom were diagnosed correctly on LDCT. One case of splenic infarction and two cases of segment colitis were missed on LDCT.

    Conclusion: The diagnostic accuracy of LDCT was high for acute diverticulitis. Therefore, it is recommended as a standard method that should help to reduce radiation dose and cost. LDCT had lower sensitivity for complications, although discrimination between an inflamed diverticulum and small pericolic abscess accounted for a proportion of the discrepancies.

  • 7.
    Thorisson, Arnar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Smedh, Kennet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Torkzad, M R
    Påhlman, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
    Chabok, Abbas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    CT imaging for prediction of complications and recurrence in acute uncomplicated diverticulitis2016In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 31, no 2, p. 451-457Article in journal (Refereed)
    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.

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