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Clin Colon Rectal Surg 2004; 17(3): 155-162
DOI: 10.1055/s-2004-832696
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Imaging of Colonic Diverticular Disease

Michael Jesse Snyder1 , 2
  • 1Department of Surgery, Baylor University, Houston, Texas
  • 2Department of Colon and Rectal Surgery, University of Texas at Houston Health Science Center, Houston, Texas
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Publication Date:
25 August 2004 (online)

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Diverticular disease affects approximately two thirds of the population over the age of 70. While only a small fraction of these patients will develop diverticulitis, adequate radiological evaluation of diverticulitis and its complications is imperative in determining proper medical and surgical treatment. Clinical examination and laboratory tests alone have been found to be inaccurate in defining many aspects of the disease in up to 60% of cases. Over the past 30 years, contrast enema, computed tomography, and ultrasound have all been used extensively to diagnose the complications of diverticular disease. More recently, magnetic resonance imaging has been studied in patients with complicated diverticulitis. This article reviews the use of these different radiological modalities in diagnosing acute colonic diverticulitis and its complications.

KEYWORDS

Radiology - diverticular disease - diverticulitis - CT scan - ultrasound - MRI

REFERENCES

  • 1 Parks T G. Natural history of diverticular disease of the colon.  Clin Gastroenterol. 1975;  4 53-69
    PubMedSearch in Google Scholar
  • 2 Labs J D, Sarr M G, Fishman E K, Siegelman S S, Cameron J L. Complications of acute diverticulitis of the colon: improved early diagnosis with computerized tomography.  Am J Surg. 1988;  155 331-336
    PubMedSearch in Google Scholar
  • 3 Freeman S R, McNally P R. Diverticulitis.  Med Clin North Am. 1993;  77 1149-1167
    PubMedSearch in Google Scholar
  • 4 Heverhagen J T, Zielke A, Ishaque N, Bohrer T, El-Sheik M, Klose K J. Acute colonic diverticulitis: visualization in magnetic resonance imaging.  Magn Reson Imaging. 2001;  19 1275-1277
    CrossrefPubMedSearch in Google Scholar
  • 5 Hayward M W, Hayward C, Ennis W P et al.. A pilot evaluation of radiography of the acute abdomen.  Clin Radiol. 1984;  35 289-291
    CrossrefPubMedSearch in Google Scholar
  • 6 Field S, Guy P J, Upsdell S M et al.. The erect abdominal radiograph in the acute abdomen: should its routine use be abandoned?.  BMJ. 1985;  290 1934-1936
    PubMedSearch in Google Scholar
  • 7 Gottesman L, Zevon S J, Brabbee G W, Darley T, Wicheru W A. The use of water-soluble contrast enema in the diagnosis of acute lower left quadrant peritonitis.  Dis Colon Rectum. 1984;  27 84-88
    PubMedSearch in Google Scholar
  • 8 Hiltunen K M, Kolehmainen H, Vuorinen T, Matikainen M. Early water-soluble contrast enema in the diagnosis of acute colonic diverticulitis.  Int J Colorectal Dis. 1991;  6 190-192
    CrossrefPubMedSearch in Google Scholar
  • 9 Wexner S D, Thomas T H. The initial management of left lower quadrant peritonitis.  Dis Colon Rectum. 1986;  29 635-638
    PubMedSearch in Google Scholar
  • 10 Nicholas G G, Miller W T, Fitts W T, Tondreau P L. Diagnosis of diverticulitis of the colon: role of the barium enema in defining pericolic inflammation.  Ann Surg. 1972;  176 205-209
    PubMedSearch in Google Scholar
  • 11 Johnson C D, Baker M E, Rice R P, Silverman P, Thompson W M. Diagnosis of diverticulitis: comparison of barium enema and CT.  AJR Am J Roentgenol. 1987;  148 541-546
    PubMedSearch in Google Scholar
  • 12 Doris P E, Strauss R W. The expanded role of the barium enema in the evaluation of patients presenting with acute abdominal pain.  J Emerg Med. 1985;  3 93-100
    CrossrefPubMedSearch in Google Scholar
  • 13 Veidenheimer M C, Berman I, Castro A F, Gallagher B M, Hales H, Salvati E P. Surgical management of diverticulitis.  Dis Colon Rectum. 1981;  24 65-72
    PubMedSearch in Google Scholar
  • 14 McKee R F, Deignan R W, Krukowski Z H. Radiological investigation in acute diverticulitis.  Br J Surg. 1993;  80 560-565
    PubMedSearch in Google Scholar
  • 15 Chappuis C W, Cohn Jr I. Acute colonic diverticulitis.  Surg Clin North Am. 1988;  68 301-313
    PubMedSearch in Google Scholar
  • 16 Stein G N. Radiology of colonic diverticular disease.  Postgrad Med. 1976;  60 95-102
    PubMedSearch in Google Scholar
  • 17 Williams S M, Nolan D J. Colosalpingeal fistula: a rare complication of colonic diverticular disease.  Eur Radiol. 1999;  9 1432-1433
    CrossrefPubMedSearch in Google Scholar
  • 18 Rossman M D, Burr L J, Thorpe P E. Colovenous fistula complicating diverticulitis: CT and radiographic findings.  Abdom Imaging. 1997;  22 513-515
    CrossrefPubMedSearch in Google Scholar
  • 19 Fleischner F G, Ming S C. Revised concepts on diverticular disease of the colon. II. So-called diverticulitis: diverticular sigmoiditis and perisigmoiditis; diverticular abscess, fistula, and frank peritonitis.  Radiology. 1965;  84 599-609
    CrossrefPubMedSearch in Google Scholar
  • 20 Schnyder P, Moss A A, Thoeni R F, Margulis A R. A double-blind study of radiological accuracy in diverticulitis, diverticulosis, and carcinomas of the sigmoid colon.  J Clin Gastroenterol. 1979;  1 55-66
    PubMedSearch in Google Scholar
  • 21 Ambrosetti P, Jenny A, Becker C, Terrier F, Morel P. Acute left colonic diverticulitis-compared performance of computed tomography and water-soluble contrast enema.  Dis Colon Rectum. 2000;  43 1363-1367
    CrossrefPubMedSearch in Google Scholar
  • 22 Birnbaum B A, Balthazar E J. CT of appendicitis and diverticulitis.  Radiol Clin North Am. 1994;  32 885-898
    PubMedSearch in Google Scholar
  • 23 Gore R M, Goldberg H I. Computed tomographic evaluation of the gastrointestinal tract in diseases other than first-degree adenocarcinoma.  Radiol Clin North Am. 1982;  20 781-796
    PubMedSearch in Google Scholar
  • 24 Hulnick D H, Megibow A J, Balthazar E J, Naidich D P, Bosniak M A. Computed tomography in the evaluation of diverticulitis.  Radiology. 1984;  152 491-495
    PubMedSearch in Google Scholar
  • 25 Rao P M, Rhea J T, Novelline R A et al.. Helical CT with only colonic contrast material for diagnosing diverticulitis: prospective evaluation of 150 patients.  AJR Am J Roentgenol. 1998;  170 1445-1449
    PubMedSearch in Google Scholar
  • 26 Birnbaum B A, Jeffrey R B. CT and sonographic evaluation of acute right lower quadrant abdominal pain.  AJR Am J Roentgenol. 1998;  170 361-371
    PubMedSearch in Google Scholar
  • 27 Lieberman J M, Haaga J R. Computed tomography of diverticulitis.  J Comput Assist Tomogr. 1983;  7 431-433
    PubMedSearch in Google Scholar
  • 28 Brengman M L, Otchy D P. Timing of computed tomography in acute diverticulitis.  Dis Colon Rectum. 1998;  41 1023-1028
    PubMedSearch in Google Scholar
  • 29 Neff C C, vanSonnenberg E. CT of diverticulitis. Diagnosis and treatment.  Radiol Clin North Am. 1989;  27 743-752
    PubMedSearch in Google Scholar
  • 30 Mueller P R, Saini S, Wittenberg J et al.. Sigmoid diverticular abscesses: percutaneous drainage as an adjunct to surgical resection in 24 cases.  Radiology. 1987;  164 321-325
    PubMedSearch in Google Scholar
  • 31 Saini S, Mueller P R, Wittenberg J et al.. Percutaneous drainage of diverticular abscess.  Arch Surg. 1986;  121 475-478
    CrossrefPubMedSearch in Google Scholar
  • 32 Cho K C, Morehouse H T, Alteman D D, Thornhill B A. Sigmoid diverticulitis: diagnostic role of CT-comparison with barium enema studies.  Radiology. 1990;  176 111-115
    CrossrefPubMedSearch in Google Scholar
  • 33 Rao P M, Rhea J T, Novelline R A. Helical CT of appendicitis and diverticulitis.  Radiol Clin North Am. 1999;  37 895-909
    CrossrefPubMedSearch in Google Scholar
  • 34 Horton K M, Corl F M, Fishman E K. CT evaluation of the colon: inflammatory disease.  Radiographics. 2000;  20 399-418
    CrossrefPubMedSearch in Google Scholar
  • 35 Pradel J A, Adell J F, Taourel P, Djafari M, Monnin-Delhom E, Bruel J M. Acute colonic diverticulitis: prospective comparative evaluation with US and CT.  Radiology. 1997;  205 503-512
    CrossrefPubMedSearch in Google Scholar
  • 36 Rao P M, Rhea J T. Colonic diverticulitis: evaluation of the arrowhead sign and the inflamed diverticulum for CT diagnosis.  Radiology. 1998;  209 775-779
    PubMedSearch in Google Scholar
  • 37 Balthazar E. Diverticular disease. Textbook of Gastrointestinal Radiology Philadelphia, PA; Saunders 1994: 1072-1097
    Search in Google Scholar
  • 38 Chintapalli K N, Chopra S, Ghiatas A A, Esola C C, Fields S F, Dodd 3rd G D. Diverticulitis versus colon cancer: differentiation with helical CT findings.  Radiology. 1999;  210 429-435
    CrossrefPubMedSearch in Google Scholar
  • 39 Molitch H I. Septic thrombophlebitis of the inferior mesenteric vein complicating sigmoid diverticulitis: CT findings.  AJR Am J Roentgenol. 1996;  167 1014-1016
    PubMedSearch in Google Scholar
  • 40 White T B, Allen III H A, Ives C E. Portal and mesenteric vein gas in diverticulitis: CT findings.  AJR Am J Roentgenol. 1998;  171 525-526
    PubMedSearch in Google Scholar
  • 41 Kim A Y, Bennett G L, Bashist B, Perlman B, Megibow A J. Small bowel obstruction associated with sigmoid diverticulitis: CT evaluation in 16 patients.  AJR Am J Roentgenol. 1998;  170 1311-1313
    PubMedSearch in Google Scholar
  • 42 Jang H J, Lim H K, Lee S J, Choi S H, Lee M H, Choi M H. Acute diverticulitis of the cecum and ascending colon: thin-section helical CT findings.  AJR Am J Roentgenol. 1999;  172 601-604
    PubMedSearch in Google Scholar
  • 43 Goldman S M, Fishman E K, Gatewood O MB. CT demonstration of colovesical fistula secondary to diverticulitis.  J Comput Assist Tomogr. 1984;  8 462-468
    PubMedSearch in Google Scholar
  • 44 Balthazar E J, Megabow A, Schinella R A et al.. Limitations in the CT diagnosis of acute diverticulitis; comparison of CT, contrast enema, and pathologic findings in 16 patients.  AJR Am J Roentgenol. 1990;  154 281-285
    PubMedSearch in Google Scholar
  • 45 Parulekar S G. Sonography of colonic diverticulitis.  J Ultrasound Med. 1985;  4 659-666
    PubMedSearch in Google Scholar
  • 46 Schwerk W B, Schwarz S, Rothmund M. Sonography in acute colonic diverticulitis. a prospective study.  Dis Colon Rectum. 1992;  35 1077-1084
    CrossrefPubMedSearch in Google Scholar
  • 47 Verbanck J, Lambrecht S, Rutgeerts L et al.. Can sonography diagnose acute colonic diverticulitis in patients with acute intestinal inflammation? A prospective study.  J Clin Ultrasound. 1989;  17 661-666
    CrossrefPubMedSearch in Google Scholar
  • 48 Wilson S R, Toi A. The value of sonography in the diagnosis of acute diverticulitis of the colon.  AJR Am J Roentgenol. 1990;  154 1199-1202
    CrossrefPubMedSearch in Google Scholar
  • 49 Hollerweger A, Rettenbacher T, Macheiner P, Brunner W, Gritzmann N. Sigmoid diverticulitis: value of transrectal sonography in addition to transabdominal sonography.  AJR Am J Roentgenol. 2000;  175 1155-1160
    PubMedSearch in Google Scholar
  • 50 Pozniak M, Scanlan K, Yandow D. Ultrasound in the evaluation of bowel disorders.  Semin Ultrasound CT MR. 1987;  8 366-384
    PubMedSearch in Google Scholar
  • 51 Kimmey M B, Martin R W, Haggitt R C et al.. Histologic correlates of gastrointestinal ultrasound images.  Gastroenterology. 1989;  96 433-441
    CrossrefPubMedSearch in Google Scholar
  • 52 Jeffrey R B, Laing F C, Townsend R R. Acute appendicitis: sonographic criteria based on 250 cases.  Radiology. 1988;  167 327-329
    CrossrefPubMedSearch in Google Scholar
  • 53 Schwerk W B, Wichtrup B, Rothmund M, Ruschoff J. Ultrasonography in the diagnosis of acute appendicitis: a prospective study.  Gastroenterology. 1989;  97 630-639
    PubMedSearch in Google Scholar
  • 54 Fleischer A C, Muhletaler C A, James A E. Sonographic assessment of the bowel wall.  AJR Am J Roentgenol. 1981;  136 887-891
    PubMedSearch in Google Scholar
  • 55 Incesu L, Coskun A, Selcuk M B, Akan H, Sozubir S, Bernay F. Acute appendicitis: MR imaging and sonographic correlation.  AJR Am J Roentgenol. 1997;  168 669-674
    CrossrefPubMedSearch in Google Scholar

Michael Jesse SnyderM.D. 

Department of Surgery, University of Texas at Houston Health Science Center

6550 Fannin St., Ste. 2307, Houston

TX 77030

Email: mjsnyder98@att.net