Ambrosetti P, Morel P
Clinic of Digestive Surgery, University Hospital of Geneva, Switzerland.
Zentralbl Chir. 1998;123(12):1382-5.
To compare the performances of computed tomography (CT) and water soluble contrast enema in the diagnosis and evaluation of the severity of acute left colonic diverticulitis, and to propose indications for elective colectomy after a first episode of diverticulitis successfully treated medically.
Prospective non-randomized study (1986-1997) of 542 patients (290 women and 252 men with a median age of 64 years) whose final diagnosis was confirmed either histologically or radiologically. 465 patients (86%) had a CT, 439 (81%) had a water soluble contrast enema, and 420 (77%) had both examinations. Diverticulitis was considered moderate when CT showed localized thickening of colonic wall (> or = 5 mm) and inflammation of pericolic fat and water soluble contrast enema showed segmental lumen narrowing and tattered mucosa; it was considered severe when abscess and/or extraluminal air/or extraluminal contrast were described by CT or the two latter by water soluble contrast enema.
410 patients (76%) were treated medically and 132 were operated during their hospitalization. Sensitivity of CT for diagnosis of diverticulitis was 96%, compared to 87% for water soluble contrast enema (p < 0.0001). Severe diverticulitis was found in 139 patients (30%) by CT and in 45 patients (11%) by water soluble contrast enema (p < 0.0001). Age < or = 50 years, severe diverticulitis in the initial CT and associated pelvic abscess were found to be statistically significant parameters to predict the risk of secondary complications after a first episode of diverticulitis successfully treated medically.
Performances of CT for diagnosis and evaluation of severity of acute diverticulitis are statistically higher than that of water soluble contrast enema. We would recommend elective colectomy in patients 50 years of age or younger with a severe diverticulitis in initial CT, and in all patients with an associated pelvic abscess.
比较计算机断层扫描（CT）和水溶性对比剂灌肠在急性左半结肠憩室炎诊断及严重程度评估中的表现，并提出在首次憩室炎经药物治疗成功后择期结肠切除术的指征。
对542例患者（290例女性和252例男性，中位年龄64岁）进行前瞻性非随机研究（1986 - 1997年），其最终诊断经组织学或放射学证实。465例患者（86%）接受了CT检查，439例（81%）接受了水溶性对比剂灌肠检查，420例（77%）接受了两种检查。当CT显示结肠壁局限性增厚（≥5mm）及结肠周围脂肪炎症，且水溶性对比剂灌肠显示节段性管腔狭窄和黏膜破损时，憩室炎被认为是中度；当CT描述有脓肿和/或腔外气体/或腔外对比剂，或水溶性对比剂灌肠描述有后两者情况时，憩室炎被认为是重度。
410例患者（76%）在住院期间接受了药物治疗，132例接受了手术。CT诊断憩室炎的敏感性为96%，而水溶性对比剂灌肠为87%（p < 0.0001）。CT发现139例患者（30%）有重度憩室炎，水溶性对比剂灌肠发现45例患者（11%）有重度憩室炎（p < 0.0001）。年龄≤50岁、初始CT显示重度憩室炎及合并盆腔脓肿被发现是预测首次憩室炎经药物治疗成功后发生继发性并发症风险的统计学显著参数。
CT在急性憩室炎诊断及严重程度评估方面的表现统计学上高于水溶性对比剂灌肠。我们建议对初始CT显示重度憩室炎的50岁及以下患者以及所有合并盆腔脓肿的患者进行择期结肠切除术。
