Rofo 2015; 187(08): 676-684
DOI: 10.1055/s-0034-1399526
Guideline
© Georg Thieme Verlag KG Stuttgart · New York

S2k Guidlines for Diverticular Disease and Diverticulitis: Diagnosis, Classification, and Therapy for the Radiologist

S2k-Leitlinie Divertikelkrankheit und Divertikulitis: Diagnostik, Klassifikation und Therapie für die Radiologie
A. G. Schreyer
1   Institute of Radiology, University Hospital Regensburg, Germany
,
G. Layer
2   Central Institute for Diagnostic and Interventional Radiology, Ludwigshafen Hospital, Germany
› Author Affiliations
Further Information

Publication History

26 January 2015

15 March 2015

Publication Date:
27 May 2015 (online)

Also available at
   Permissions and Reprints

Abstract

Diverticular disease and diverticulitis represent an increasingly common disease especially in patients with advanced age. The German Society of Digestive and Metabolic Diseases (DGVS) as well as the German Society of General and Visceral Surgery (DGAV) in collaboration with the German Radiology Society (DRG) created and published S2k guidelines regarding this topic. Knowledge of the diagnosis and therapy of this common disease is extremely important for the radiologist for the daily clinical routine. In this article we review and discuss the most important clinical situations and algorithms of this disease focusing on radiological topics. Additionally, we introduce the new CCD (classification of diverticular disease) system regarding radiology.

Key Points:

• For the diagnosis of a diverticular disease a sectional imaging method should be performed. First choice should be a „qualified ultrasound examination“ followed by CT in uncertain situations or complicated disease.

• Disease classification should be done according the new CCD (Classification of diverticular disease) algorithm.

• Based on this new CCD patients can be stratified into outpatient, in-house patient and surgical treatment therapy.

Citation Format:

• Schreyer AG, Layer G. S2k Guidlines for Diverticular Disease and Diverticulitis: Diagnosis, Classification, and Therapy for the Radiologist. Fortschr Röntgenstr 2015; 187: 676 – 684

Zusammenfassung

Die Divertikulose und die Divertikelkrankheit ist mit zunehmendem Patientenalter eine der häufigsten Erkrankungen des gastrointestinalen Traktes. Die neue S2k-Leitlinie zur „Divertikelkrankheit/Divertikulitis“ der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) unter Beteiligung der Deutschen Röntgengesellschaft (DRG) wurde dazu aktuell erstellt und veröffentlicht. Dieses häufige Krankheitsbild betrifft besonders den Radiologen hinsichtlich der Diagnose- und Therapieentscheidungen in der täglichen klinischen Routine in zunehmendem Maße. Im vorliegenden Artikel werden die wichtigsten diagnostischen und therapeutischen Szenarien und Algorithmen der Erkrankung mit dem Fokus auf die Radiologie zusammengefasst und diskutiert. Zusätzlich wird die neu erstellte Klassifikation CDD (Classification of Diverticular Disease) erläutert und ihre Auswirkung auf die Radiologie besprochen.

Key words

abdomen - CT - MR imaging - inflammation

Deutscher Artikel/German Article

 

  • References

  • 1 Golder M, Ster IC, Babu P et al. Demographic determinants of risk, colon distribution and density scores of diverticular disease. World journal of gastroenterology 2011; 17: 1009-1017
    PubMedGoogle Scholar
  • 2 Hughes LE. Postmortem survey of diverticular disease of the colon. I. Diverticulosis and diverticulitis. Gut 1969; 10: 336-344
    CrossrefPubMedGoogle Scholar
  • 3 Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Advances in surgery 1978; 12: 85-109
    PubMedGoogle Scholar
  • 4 Hansen O, Stock W. Prophylaktische Operation bei der Divertikelkrankheit des Kolons – Stufenkonzept durch exakte Stadieneinteilung. Langenbeck's archives of surgery/Deutsche Gesellschaft fur Chirurgie 1999; 115: 1257-1260
    PubMedGoogle Scholar
  • 5 AWMF. Klassifikation S2-Leitlinien. 2014 http://www.awmf.org/leitlinien/awmf-regelwerk/ll-entwicklung/awmf-regelwerk-01-planung-und-organisation/po-stufenklassifikation/klassifikation-s2e-und-s2k.html (accessed 19.12.2014 2014)
    PubMedGoogle Scholar
  • 6 Andersen JC, Bundgaard L, Elbrond H et al. Danish national guidelines for treatment of diverticular disease. Danish medical journal 2012; 59: C4453
    PubMedGoogle Scholar
  • 7 Leifeld L, Germer CT, Bohm S et al. S2k guidelines diverticular disease/diverticulitis. Zeitschrift fur Gastroenterologie 2014; 52: 663-710
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Parks TG. Natural history of diverticular disease of the colon. A review of 521 cases. British medical journal 1969; 4: 639-642
    CrossrefPubMedGoogle Scholar
  • 9 West AB, Losada M. The pathology of diverticulosis coli. Journal of clinical gastroenterology 2004; 38: S11-S16
    CrossrefPubMedGoogle Scholar
  • 10 Commane DM, Arasaradnam RP, Mills S et al. Diet, ageing and genetic factors in the pathogenesis of diverticular disease. World journal of gastroenterology 2009; 15: 2479-2488
    CrossrefPubMedGoogle Scholar
  • 11 Delvaux M. Diverticular disease of the colon in Europe: epidemiology, impact on citizen health and prevention. Alimentary pharmacology & therapeutics 2003; 18: 71-74
    CrossrefPubMedGoogle Scholar
  • 12 Etzioni DA, Mack TM, Beart RW Jr et al. Diverticulitis in the United States: 1998–2005: changing patterns of disease and treatment. Annals of surgery 2009; 249: 210-217
    CrossrefPubMedGoogle Scholar
  • 13 Granlund J, Svensson T, Olen O et al. The genetic influence on diverticular disease – a twin study. Alimentary pharmacology & therapeutics 2012; 35: 1103-1107
    PubMedGoogle Scholar
  • 14 Painter NS, Burkitt DP. Diverticular disease of the colon: a deficiency disease of Western civilization. British medical journal 1971; 2: 450-454
    CrossrefPubMedGoogle Scholar
  • 15 Lin OS, Soon MS, Wu SS et al. Dietary habits and right-sided colonic diverticulosis. Diseases of the colon and rectum 2000; 43: 1412-1418
    CrossrefPubMedGoogle Scholar
  • 16 Manousos ON, Vrachliotis G, Papaevangelou G et al. Relation of diverticulosis of the colon to environmental factors in Greece. The American journal of digestive diseases 1973; 18: 174-176
    CrossrefPubMedGoogle Scholar
  • 17 Peery AF, Barrett PR, Park D et al. A high-fiber diet does not protect against asymptomatic diverticulosis. Gastroenterology 2012; 142: 266-272 e1
    CrossrefPubMedGoogle Scholar
  • 18 Song JH, Kim YS, Lee JH et al. Clinical characteristics of colonic diverticulosis in Korea: a prospective study. The Korean journal of internal medicine 2010; 25: 140-146
    CrossrefPubMedGoogle Scholar
  • 19 Strate LL, Liu YL, Syngal S et al. Nut, corn, and popcorn consumption and the incidence of diverticular disease. Journal of the American Medical Association 2008; 300: 907-914
    CrossrefPubMedGoogle Scholar
  • 20 Strate LL, Liu YL, Aldoori WH et al. Obesity increases the risks of diverticulitis and diverticular bleeding. Gastroenterology 2009; 136: 115-122 e1
    CrossrefPubMedGoogle Scholar
  • 21 Hwang SS, Cannom RR, Abbas MA et al. Diverticulitis in transplant patients and patients on chronic corticosteroid therapy: a systematic review. Diseases of the colon and rectum 2010; 53: 1699-1707
    CrossrefPubMedGoogle Scholar
  • 22 Poncet G, Heluwaert F, Voirin D et al. Natural history of acute colonic diverticular bleeding: a prospective study in 133 consecutive patients. Alimentary pharmacology & therapeutics 2010; 32: 466-471
    CrossrefPubMedGoogle Scholar
  • 23 Kaser SA, Fankhauser G, Glauser PM et al. Diagnostic value of inflammation markers in predicting perforation in acute sigmoid diverticulitis. World journal of surgery 2010; 34: 2717-2722
    CrossrefPubMedGoogle Scholar
  • 24 Toorenvliet BR, Bakker RF, Breslau PJ et al. Colonic diverticulitis: a prospective analysis of diagnostic accuracy and clinical decision-making. Colorectal disease: the official journal of the Association of Coloproctology of Great Britain and Ireland 2010; 12: 179-186
    CrossrefPubMedGoogle Scholar
  • 25 Laurell H, Hansson LE, Gunnarsson U. Acute diverticulitis – clinical presentation and differential diagnostics. Colorectal disease 2007; 9: 496-501
    CrossrefPubMedGoogle Scholar
  • 26 Schwerk WB, Schwarz S, Rothmund M. Sonography in acute colonic diverticulitis. A prospective study. Diseases of the colon and rectum 1992; 35: 1077-1084
    CrossrefPubMedGoogle Scholar
  • 27 Pradel JA, Adell JF, Taourel P et al. Acute colonic diverticulitis: prospective comparative evaluation with US and CT. Radiology 1997; 205: 503-512
    CrossrefPubMedGoogle Scholar
  • 28 Schreyer AG, Menzel C, Friedrich C et al. Comparison of high-resolution ultrasound and MR-enterography in patients with inflammatory bowel disease. World journal of gastroenterology 2011; 17: 1018-1025
    PubMedGoogle Scholar
  • 29 Lameris W, van Randen A, Bipat S et al. Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy. European radiology 2008; 18: 2498-2511
    CrossrefPubMedGoogle Scholar
  • 30 Liljegren G, Chabok A, Wickbom M et al. Acute colonic diverticulitis: a systematic review of diagnostic accuracy. Colorectal disease: the official journal of the Association of Coloproctology of Great Britain and Ireland 2007; 9: 480-488
    CrossrefPubMedGoogle Scholar
  • 31 Gielens MP, Mulder IM, van der Harst E et al. Preoperative staging of perforated diverticulitis by computed tomography scanning. Techniques in coloproctology 2012; 16: 363-368
    CrossrefPubMedGoogle Scholar
  • 32 Tack D, Bohy P, Perlot I et al. Suspected acute colon diverticulitis: imaging with low-dose unenhanced multi-detector row CT. Radiology 2005; 237: 189-196
    CrossrefPubMedGoogle Scholar
  • 33 Heverhagen JT, Sitter H, Zielke A et al. Prospective evaluation of the value of magnetic resonance imaging in suspected acute sigmoid diverticulitis. Diseases of the colon and rectum 2008; 51: 1810-1815
    CrossrefPubMedGoogle Scholar
  • 34 Schreyer AG, Furst A, Agha A et al. Magnetic resonance imaging based colonography for diagnosis and assessment of diverticulosis and diverticulitis. International journal of colorectal disease 2004; 19: 474-480
    PubMedGoogle Scholar
  • 35 Ajaj W, Ruehm SG, Lauenstein T et al. Dark-lumen magnetic resonance colonography in patients with suspected sigmoid diverticulitis: a feasibility study. European radiology 2005; 15: 2316-2322
    CrossrefPubMedGoogle Scholar
  • 36 Sakhnini E, Lahat A, Melzer E et al. Early colonoscopy in patients with acute diverticulitis: results of a prospective pilot study. Endoscopy 2004; 36: 504-507
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Chintapalli KN, Chopra S, Ghiatas AA et al. Diverticulitis versus colon cancer: differentiation with helical CT findings. Radiology 1999; 210: 429-435
    CrossrefPubMedGoogle Scholar
  • 38 Oistamo E, Hjern F, Blomqvist L et al. Cancer and diverticulitis of the sigmoid colon. Differentiation with computed tomography versus magnetic resonance imaging: preliminary experiences. Acta radiologica 2013; 54: 237-241
    CrossrefPubMedGoogle Scholar
  • 39 Bahadursingh AM, Virgo KS, Kaminski DL et al. Spectrum of disease and outcome of complicated diverticular disease. American journal of surgery 2003; 186: 696-701
    CrossrefPubMedGoogle Scholar
  • 40 Siewert B, Tye G, Kruskal J et al. Impact of CT-guided drainage in the treatment of diverticular abscesses: size matters. Am J Roentgenol American journal of roentgenology 2006; 186: 680-686
    PubMedGoogle Scholar
  • 41 Brandt D, Gervaz P, Durmishi Y et al. Percutaneous CT scan-guided drainage vs. antibiotherapy alone for Hinchey II diverticulitis: a case-control study. Diseases of the colon and rectum 2006; 49: 1533-1538
    CrossrefPubMedGoogle Scholar
  • 42 Zuckerman GR, Prakash C. Acute lower intestinal bleeding. Part II: etiology, therapy, and outcomes. Gastrointestinal endoscopy 1999; 49: 228-238
    CrossrefPubMedGoogle Scholar