Is it possible to limit the use of CT scanning in acute diverticular disease without compromising outcomes? A preliminary experience

Abstract

The aim of our study was to determine whether the use of CT scanning in the assessment of acute diverticulitis can be reduced without a negative effect on outcome.

Our series consisted of 93 out of 100 patients with acute diverticulitis admitted to the Emergency Room of our institution in the period from February 2012 to March 2013. The Hinchey classification system was used to stage disease based on findings on ultrasound (US) examination and/or computed tomography (CT) scanning. We compared the patients’ Hinchey stage (HS) on admission and 72 hours later. Types of treatment were defined as emergency or delayed intervention (operative approaches (OA); ultrasound-guided percutaneous drainage (UPD), and surgery. The borderline between conservative and surgical management was identified. In patients with a HS </= 1b surgical intervention was never required and therefore we believe that US imaging is sufficient and they can be spared the exposure to ionizing radiation associated with CT scans. The skill of the individual operator in US examination was found to be of key importance. As regards CT scanning, we found, in agreement with the literature, that it has greater specificity and sensitivity than US, and is therefore indicated if the patient’s condition has deteriorated.