A. Hollerweger et al., Sigmoid Diverticulitis: Value of transrectal sonography in addition to transabdominal sonography, AM J ROENTG, 175(4), 2000, pp. 1155-1160
Citations number
18
Categorie Soggetti
Radiology ,Nuclear Medicine & Imaging","Medical Research Diagnosis & Treatment
OBJECTIVE. Overlying intestinal gas often impairs transabdominal sonographi
c assessment of the lower sigmoid colon. The aim of this study was to inves
tigate the usefulness of transrectal sonography in addition to transabdomin
al sonography for the evaluation of sigmoid diverticulitis.
SUBJECTS AND METHODS. Eighty-six consecutive patients with clinically suspe
cted acute sigmoid diverticulitis were referred for transabdominal sonograp
hy as the initial imagine, method. In 46 patients, transrectal sonography w
as performed in addition to transabdominal sonography if pain was localized
to the mid lower abdomen and if a disease process could not be visualized
or could be only partially visualized on transabdominal examination. An end
-firing 5-9-MHz endocavitary probe was used for transrectal sonography.
RESULTS, Thirty-four of 50 patients with a final diagnosis of sigmoid diver
ticulitis underwent both transabdominal and transrectal sonography. In 20 p
atients, transrectal sonography showed relevant additional information: six
diagnoses of diverticulitis were established on transrectal sonography alo
ne. Transrectal sonography revealed one perforation, five abscesses, and th
ree fistulous complications that were not shown on transabdominal sonograph
y. In the remaining five patients, correct diagnoses were supported on tran
sabdominal examinations, but only transrectal sonography could show an infl
amed diverticulum. In 10 patients, transrectal sonography revealed signs of
diverticulitis but no relevant information in addition to the results from
transabdominal sonography. Four false-negative and two false-positive resu
lts were revealed with transrectal sonography.
CONCLUSION, Transrectal sonography is accurate for confirming clinically su
spected acute colonic diverticulitis when the lower sigmoid colon is affect
ed. It helps avoid false-negative results and defines the severity of disea
se in the lower sigmoid colon better than transabdominal sonography alone.
Transrectal sonography can increase the sensitivity of sonography for diagn
osing sigmoid diverticulitis.