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2015 ; 97
(3
): 208-14
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Validation of a grading system for complicated diverticulitis in the prediction
of need for operative or percutaneous intervention
#MMPMID26263806
Fung AK
; Ahmeidat H
; McAteer D
; Aly EH
Ann R Coll Surg Engl
2015[Apr]; 97
(3
): 208-14
PMID26263806
show ga
INTRODUCTION: The current surgical management of acute complicated diverticulitis
has seen a major paradigm shift from routine operative intervention to a more
conservative approach. This has been made possible by the widespread availability
of computed tomography (CT) to enable stratification of the disease severity of
acute complicated diverticulitis. The aim of this study was to retrospectively
validate a CT grading system for acute complicated diverticulitis in the
prediction of the need for operative or percutaneous intervention. METHODS:
Hospital and radiology records were reviewed to identify patients with acute
complicated diverticulitis confirmed by CT. A consultant gastrointestinal
radiologist, blinded to the clinical outcomes of patients, assigned a score
according to the CT grading system. RESULTS: Three hundred and sixty-seven
patients (34.6%) had CT performed for acute diverticulitis during the study
period. Forty-four patients (12.0%) had acute complicated diverticulitis (abscess
and/or free intraperitoneal air) confirmed on CT. There were 22 women (50%) and
the overall median age was 59 years (range: 19-92 years). According to the CT
findings, there was one case with grade 1, eighteen patients with grade 2, four
with grade 3 and twenty-one with grade 4 diverticulitis. Three patients with
grade 2, three patients with grade 3 and ten patients with grade 4 disease
underwent acute radiological or surgical intervention. CONCLUSIONS: The use of a
CT grading system for acute complicated diverticulitis did not predict the need
for acute radiological or operative intervention in this small study. Decision
making guided by the patient's clinical condition still retains a primary role in
the management of acute complicated diverticulitis.