COMPUTED-TOMOGRAPHY IN ACUTE LEFT COLONIC DIVERTICULITIS

Background The use of computed tomography (CT) in acute left colonic d iverticulitis remains controversial. The purpose of this study was to define the value of CT both during the acute phase of inflammation and , later, to indicate secondary complications after successful medical treatment. Methods Some 423 patients with radiologically or histologic ally proven diverticulitis were studied prospectively from 1986 to 199 5. Diverticulitis was considered moderate when CT showed localized thi ckening of the colonic wall (5 mm or more) and inflammation of pericol ic fat; it was considered severe when abscess and/or extraluminal air and/or extraluminal contrast were observed. Results The sensitivity of CT was 97 per cent. Of 42 patients who failed conservative treatment, 32 had severe diverticulitis on CT, compared with 74 (24 per cent) of 303 who had successful conservative treatment (P < 0.0001). After a m edian follow-up of 46 months, 60 (20 per cent) of 300 patients had sec ondary complications despite initially successful conservative treatme nt: 28 (47 per cent) of these had initial severe diverticulitis on CT compared with 44 (19 per cent) of 236 patients who had no complication s (P < 0.0001). Conclusion Abscess formation and extracolonic contrast or gas are findings that may be used to predict failure of medical tr eatment during the first admission and a high risk of secondary compli cations after initially successful medical management of acute diverti culitis.