Aims and objectives
Acute diverticulitis is the commonest emergency admission to the Lothian Colorectal Unit,
the largest colorectal unit in the UK.
The incidence of complicated diverticular disease,
associated with abscess and/or perforation is increasing [1,2].
Surgical intervention in acute,
complicated disease often results in stoma formation,
which can remain permanent .
attempts to eradicate intra-abdominal collections and control sepsis as either a preparatory step to elective surgery or as a definitive mode of treatment are gaining popularity.
This may be achieved by percutaneous CT guided drainage...
Methods and materials
Data for a one year period,
April 2013 – 14 inclusive,
was collected for all acute colonic diverticulitis admissions from Lothian Surgical Audit (LSA) a prospective surgical database.
The investigative and management pathways for all cases were searched on TRAK (the electronic hospital records and results) and PACS (the radiology picture archiving and communication system).
The radiological and surgical management pathways of all cases were scrutinised and demographic,
intervention and outcome data was collected.
The CRP (mg/L) within 24 hours of admission was...
234 consecutive acute diverticular cases over a 1 year period:
•195 (74%): simple uncomplicated (Hinchey Ia) •34 (13%): Complicated with abscess/perforation (Hinchey Ib,
II) •5 (2%): complicated by large bowel obstruction
Surgery in the Acute Episode
Surgical intervention was required in 51 (20%) of all acute diverticular presentations
Complicated Diverticulitis - Abscess /Perforation
13 (39%) of the cohort with perforation/abscess at index admission required emergency surgery.
•All had abscess >4 cm maximum diameter (range 4 – 17cm) •Stoma rate of 54%
Percutaneous drainage ( PCD)...
The increasing incidence of colonic diverticulitis,
particularly in the 45-55 year old cohort,
creates clinical and financial burdens on surgical and radiological services within all colorectal departments.
This appears to be an upward trend with regards to complicated disease.
The clinical and financial implications of utilising CRP as a tool to trigger or prevent CT scanning deserves further assessment.
CT imaging for the diverticulitis cohort can potentially be more selectively utilised when guided by the admission CRP [figs xyz 8,9]. With a threshold as low...
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