Inflammation, Diverticula, Abscess, Drainage, CT, Gastrointestinal tract
D. N. Anderson; Edinburgh/UK
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) and Laparoscopy and lavage
Laparoscopy and lavage was performed in 2 acute cases with 6 cm and 7 cm collections not suitable for PCD.
Both failed to progress and required Hartmann's resection.
PCD was used for only 5 of the 235 patients.
3 underwent PCD at presentation then required open intervention.
A further 2 patients underwent PCD of postoperative collections.
CRP measurements (mg/L)
1.The CRP at admission was significantly raised in the cohort with complicated diverticulitis compared to those with CT diagnosed simple/uncomplicated diverticulitis: median 246 vs 48 mg/L respectively; p< 0.0001 (Fig.1).
2.The CRP was also significantly higher in the cohort with complicated diverticulitis who required surgical intervention: median 284 vs 214 mg/L; p < 0.03.
If a "threshold" admission CRP may had been utilised to "trigger" a CT Scan,
the burdens on inpatient radiology service would be greatly reduced and significant savings could be made by institutions,
without the risk of missing patients with complicated diverticulitis.
The cost of an urgent CT scan in our institute is over £200 pounds.
The total cost of 195 CT scans for the cohort with simple uncomplicated (Hinchey 1a) diverticulitis in a 1 year period was therefore £39,000.
The cost reduction by utilising a CRP threshold of > 150mg/L to trigger a CT scan at presentation would equate to a saving over a 1 year period on the current expenditure in the uncomplicated simple acute diverticulitis cohort of £35,880.
At the lower threshold of CRP >50mg/L a saving of £20 670 could be achieved with no risk of missing a complicated case.