Ripollés Tomás, Agramunt Marcos, Martínez María Jesús, Costa Salvador, Gómez-Abril Segundo A, Richart José
Department of Radiology, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Avenue, 46017 Valencia, Spain.
Eur Radiol. 2003 Dec;13(12):2587-95. doi: 10.1007/s00330-003-1861-4. Epub 2003 May 22.
The aim of this study was to evaluate the role of ultrasound in the diagnosis and management of acute diverticulitis and its capacity to predict posterior complications in patients undergoing medical treatment. A review was made of the histories of 208 hospitalized patients (262 admissions) initially diagnosed with acute diverticulitis over a 5-year period. Ultrasound was performed in all patients upon first admission. Diverticulitis was retrospectively classified as either simple or complicated, the latter being defined by the presence of extraluminal air and/or abscesses. Diverticulitis was finally diagnosed in 203 patients. Ultrasound exhibited a sensitivity of 86% in 77 cases subjected to surgery, and of 94% in the global 203 patients (192 true-positive and 11 false-negative findings). Of 34 patients with diverticulitis and emergency surgery, 10 had false-negative US exams. Twenty of the 73 cases (27%) with signs of complicated diverticulitis in the initial ultrasound study required emergency surgery, compared with only 4 of the 119 patients (3%) with US evidence of simple diverticulitis (p<0.001). Of the 169 patients with diverticulitis undergoing conservative management, 54 (32%) developed complications during follow-up. The patients under age 50 years with signs of complicated diverticulitis suffered more complications (65%) than the rest of groups (p<0.001). In subjects with recurrences (26%), these were either similar to or less than the first episode in 84% of the cases. The present study shows that ultrasound constitutes a feasible technique for diagnosing acute diverticulitis. The severity of diverticulitis according to US is statistically predictive of surgical risk during the acute phase. Severity is also related to the appearance of posterior complications in patients undergoing conservative management, although only in younger patients (<50 years).
本研究的目的是评估超声在急性憩室炎的诊断和管理中的作用，以及其预测接受药物治疗患者后期并发症的能力。回顾了208例住院患者（262次入院）的病史，这些患者在5年期间最初被诊断为急性憩室炎。所有患者首次入院时均接受了超声检查。憩室炎被回顾性地分为单纯性或复杂性，后者由腔外气体和/或脓肿的存在来定义。最终203例患者被诊断为憩室炎。超声在77例接受手术的患者中敏感性为86%，在全部203例患者中敏感性为94%（192例假阳性和11例假阴性结果）。在34例患有憩室炎并接受急诊手术的患者中，10例超声检查结果为假阴性。在初始超声检查中有复杂憩室炎迹象的73例患者中，20例（27%）需要急诊手术，相比之下，在超声显示为单纯性憩室炎的119例患者中，只有4例（3%）需要急诊手术（p<0.001）。在169例接受保守治疗的憩室炎患者中，54例（32%）在随访期间出现并发症。年龄小于50岁且有复杂憩室炎迹象的患者比其他组更容易出现并发症（65%）（p<0.001）。在复发的患者中（26%），84%的病例复发情况与首次发作相似或较轻。本研究表明，超声是诊断急性憩室炎的一种可行技术。根据超声判断的憩室炎严重程度在统计学上可预测急性期的手术风险。严重程度也与接受保守治疗患者后期并发症的出现有关，不过仅在年轻患者（<50岁）中如此。
