Al-Saadi Hassan, Abdulrasool Haider, Murphy Elizabeth
General Surgery, Western Health, Melbourne, AUS.
General Surgery, Lyell McEwin Hospital, Adelaide, AUS.
Cureus. 2023 Feb 6;15(2):e34709. doi: 10.7759/cureus.34709. eCollection 2023 Feb.
Background Acute diverticulitis is a common surgical condition and one of the leading gastrointestinal conditions that require hospital admission. The presence of complications increases the hospital stay and risk of requiring surgical intervention. This study aimed to investigate the clinical features that can be identified during clinical assessment and evaluate their predictive value and sensitivity in differentiating between complicated and uncomplicated diverticulitis. Methodology This retrospective case-control study was performed on patients with acute diverticulitis at Lyell McEwin Hospital, Adelaide, South Australia. Data were collected for patients presenting from January 2015 to December 2017. Patients with acute diverticulitis confirmed by computed tomography (CT) were included in the study. Multiple clinical assessment aspects were reported and compared between complicated diverticulitis and uncomplicated diverticulitis groups. Results Data from a total of 116 cases were collected, 10 of which were excluded due to lack of CT diagnosis. Forty-four cases had complicated diverticulitis (case group), and 62 cases had uncomplicated diverticulitis (control group). Twenty-three cases (52.2%) had the first episode of diverticulitis in the complicated group compared to 24 cases (38.7%) in the uncomplicated group, with an odds ratio of 1.73 (0.79-3.789). Eight cases (18.2%) had previously complicated diverticulitis in the complicated group compared to 11 cases (17.7%) in the uncomplicated group, with an odds ratio of 1.03 (0.37-2.82). Six cases (13.6%) had a fever ( > 38) in the complicated group compared to two cases (3.2%) in the uncomplicated group, with an odds ratio of 4.74 (0.9-24.7), a sensitivity of only 13.64%, and a specificity of 96.77%. Twelve cases (27.3%) had tachycardia, two cases (4.5%) had hypotension, and five cases (11.4%) had peritonism in the complicated group compared to two cases (3.2%), one case (1.6%), and one case (1.6%) in the uncomplicated group, with odds ratios of 11.25 (2.37-53.4), 2.9 (0.255-33), and 7.82 (0.88-69.5), respectively; sensitivity was 27.27%, 4.55%, and 11.36% for tachycardia, hypotension, and peritonism, whereas specificity was 96.77%, 98.39%, and 98.39%, respectively. Conclusions The study found no significant correlation between having complicated diverticulitis and previous episodes of complicated diverticulitis, immunosuppression, pain severity, or change in bowel habits. Perrectal bleeding was found to reduce the risk of having complicated diverticulitis. Our results did not demonstrate a statistically significant relationship between the first episode of diverticulitis and having complicated diverticulitis. Physical signs, when abnormal, are highly specific in predicting complicated diverticulitis. Tachycardia was found to have the highest positive predictive value and odds ratio compared to the other observed physical signs.
急性憩室炎是一种常见的外科疾病，也是需要住院治疗的主要胃肠道疾病之一。并发症的出现会延长住院时间并增加手术干预的风险。本研究旨在调查临床评估中可识别的临床特征，并评估它们在区分复杂性和非复杂性憩室炎方面的预测价值和敏感性。
本回顾性病例对照研究对南澳大利亚阿德莱德莱尔·麦克尤恩医院的急性憩室炎患者进行。收集了2015年1月至2017年12月就诊患者的数据。经计算机断层扫描（CT）确诊为急性憩室炎的患者纳入研究。报告并比较了复杂性憩室炎组和非复杂性憩室炎组的多个临床评估方面。
共收集了116例患者的数据，其中10例因缺乏CT诊断而被排除。44例为复杂性憩室炎（病例组），62例为非复杂性憩室炎（对照组）。复杂性憩室炎组中23例（52.2%）为首次发作憩室炎，非复杂性憩室炎组为24例（38.7%），比值比为1.73（0.79 - 3.789）。复杂性憩室炎组中8例（18.2%）既往有复杂性憩室炎，非复杂性憩室炎组为11例（17.7%），比值比为1.03（0.37 - 2.82）。复杂性憩室炎组6例（13.6%）发热（>38），非复杂性憩室炎组2例（3.2%），比值比为4.74（0.9 - 24.7），敏感性仅为13.64%，特异性为96.77%。复杂性憩室炎组12例（27.3%）有心动过速，2例（4.5%）有低血压，5例（11.4%）有腹膜炎，非复杂性憩室炎组分别为2例（3.2%）、1例（1.6%）和1例（提示此处有误，原文为1例，按照逻辑推测此处应为1例（1.6%）），比值比分别为11.25（2.37 - 53.4）、2.9（0.255 - 33）和7.82（0.88 - 69.5）；心动过速、低血压和腹膜炎的敏感性分别为27.27%、4.55%和11.36%，而特异性分别为96.77%、98.39%和98.39%。
研究发现复杂性憩室炎与既往复杂性憩室炎发作、免疫抑制、疼痛严重程度或排便习惯改变之间无显著相关性。发现直肠出血可降低发生复杂性憩室炎的风险。我们的结果未显示憩室炎首次发作与复杂性憩室炎之间存在统计学显著关系。体征异常时，对预测复杂性憩室炎具有高度特异性。与其他观察到的体征相比，心动过速具有最高的阳性预测价值和比值比。
