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Clin Colon Rectal Surg 2004; 17(3): 155-162
DOI: 10.1055/s-2004-832696
DOI: 10.1055/s-2004-832696
Imaging of Colonic Diverticular Disease
Further Information
Publication History
Publication Date:
25 August 2004 (online)
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
- 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
- 3 Freeman S R, McNally P R. Diverticulitis. Med Clin North Am. 1993; 77 1149-1167
- 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
- 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
- 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
- 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
- 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
- 9 Wexner S D, Thomas T H. The initial management of left lower quadrant peritonitis. Dis Colon Rectum. 1986; 29 635-638
- 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
- 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
- 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
- 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
- 14 McKee R F, Deignan R W, Krukowski Z H. Radiological investigation in acute diverticulitis. Br J Surg. 1993; 80 560-565
- 15 Chappuis C W, Cohn Jr I. Acute colonic diverticulitis. Surg Clin North Am. 1988; 68 301-313
- 16 Stein G N. Radiology of colonic diverticular disease. Postgrad Med. 1976; 60 95-102
- 17 Williams S M, Nolan D J. Colosalpingeal fistula: a rare complication of colonic diverticular disease. Eur Radiol. 1999; 9 1432-1433
- 18 Rossman M D, Burr L J, Thorpe P E. Colovenous fistula complicating diverticulitis: CT and radiographic findings. Abdom Imaging. 1997; 22 513-515
- 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
- 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
- 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
- 22 Birnbaum B A, Balthazar E J. CT of appendicitis and diverticulitis. Radiol Clin North Am. 1994; 32 885-898
- 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
- 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
- 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
- 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
- 27 Lieberman J M, Haaga J R. Computed tomography of diverticulitis. J Comput Assist Tomogr. 1983; 7 431-433
- 28 Brengman M L, Otchy D P. Timing of computed tomography in acute diverticulitis. Dis Colon Rectum. 1998; 41 1023-1028
- 29 Neff C C, vanSonnenberg E. CT of diverticulitis. Diagnosis and treatment. Radiol Clin North Am. 1989; 27 743-752
- 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
- 31 Saini S, Mueller P R, Wittenberg J et al.. Percutaneous drainage of diverticular abscess. Arch Surg. 1986; 121 475-478
- 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
- 33 Rao P M, Rhea J T, Novelline R A. Helical CT of appendicitis and diverticulitis. Radiol Clin North Am. 1999; 37 895-909
- 34 Horton K M, Corl F M, Fishman E K. CT evaluation of the colon: inflammatory disease. Radiographics. 2000; 20 399-418
- 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
- 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
- 37 Balthazar E. Diverticular disease. Textbook of Gastrointestinal Radiology Philadelphia, PA; Saunders 1994: 1072-1097
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- 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
- 39 Molitch H I. Septic thrombophlebitis of the inferior mesenteric vein complicating sigmoid diverticulitis: CT findings. AJR Am J Roentgenol. 1996; 167 1014-1016
- 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
- 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
- 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
- 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
- 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
- 45 Parulekar S G. Sonography of colonic diverticulitis. J Ultrasound Med. 1985; 4 659-666
- 46 Schwerk W B, Schwarz S, Rothmund M. Sonography in acute colonic diverticulitis. a prospective study. Dis Colon Rectum. 1992; 35 1077-1084
- 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
- 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
- 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
- 50 Pozniak M, Scanlan K, Yandow D. Ultrasound in the evaluation of bowel disorders. Semin Ultrasound CT MR. 1987; 8 366-384
- 51 Kimmey M B, Martin R W, Haggitt R C et al.. Histologic correlates of gastrointestinal ultrasound images. Gastroenterology. 1989; 96 433-441
- 52 Jeffrey R B, Laing F C, Townsend R R. Acute appendicitis: sonographic criteria based on 250 cases. Radiology. 1988; 167 327-329
- 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
- 54 Fleischer A C, Muhletaler C A, James A E. Sonographic assessment of the bowel wall. AJR Am J Roentgenol. 1981; 136 887-891
- 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
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