Learning objectives
1.- Update current knowledge on the capacity of radiological techniques to differentiate sigmoiditis/acute diverticulitis from colon cancer.
2.- Describe and illustrate the orienting CT findings (computed tomography).
Background
Individuals living in industrialized countries face an approximately 60% risk of developing colon diverticula (1).
Acute diverticulitis is one of the causes of hospitalization,
affecting up to 25% of patients with diverticulosis (2,
3).
The assessment and management of acute diverticulitis have evolved steadily in recent decades.
There has recently been a significant increase in the use of CT to confirm the acute diverticulitis diagnosis,
with a trend toward conservative treatment over surgical resection (4,
5).
Surgery is commonly reserved for cases of Hinchey III/IV...
Findings and procedure details
Current internationally-accepted directives recommend routine colonoscopy following an acute episode to confirm the diagnosis and rule out malignancy,
given the frequent similarities between the clinical-radiological presentations of acute diverticulitis and colon cancer.
This recommendation is based on studies performed prior to the use of high-quality CT,
in cases in which evidence of low performance of CT orient a diagnosis of malignancy or benignancy was found.
One example of the scenario described are the results published by Chintapalli et al (6).
They performed a retrospective analysis...
Conclusion
It is possible to orient the diagnosis of the inflammatory or neoplastic origin of a colon segment affected by sigmoiditis/acute diverticulitis with high reliability using radiological tests.
Their performance appears to be directly related with the use of CT of greater quality,
and the consolidation of recently-developed techniques with promising results such as the PCT,
CCT and the use of T2- weighted MRI and diffusion-weighted MRI.
Nonetheless,
the evidence is still too limited for radiological tests to replace the current routine usage of the colonoscopy...
References
1)Floch MH,
White JA.
Management of diverticular disease ischanging.
World J Gastroenterol2006; 12: 3225-3228.
2)Sandler RS,
Everhart JE,
Donowitz M,
Adams E,
Cronin K,
Goodman C et al.
The burden of selected digestive diseases in the United States.Gastroenterology 2002; 122: 1500-1511.
3)Warner E,
Crighton EJ,
Moineddin R,
Mamdani M,
Upshur R.Fourteen-year study of hospital admissions for diverticulardisease in Ontario.
Can J Gastroenterol2007; 21: 97-99.
4)Peppas G,
Bliziotis IA,
Oikonomaki D,
Falagas ME.
Outcomesafter medical and surgical treatment of diverticulitis:a systematic review of the available evidence....