1 / 28

Diagnosis of diverticulosis and diverticulitis

Diagnosis of diverticulosis and diverticulitis. Tryggvi Björn Stefánsson Dept of Surgery Landspitali University Hospital. Diverticulosis. Barium Enema. Barium Enema. Diverticulitis. Clinical classification Hinchey classification Ambrosetti classification.

ocasio
Download Presentation

Diagnosis of diverticulosis and diverticulitis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Diagnosis of diverticulosis and diverticulitis Tryggvi Björn Stefánsson Dept of Surgery Landspitali University Hospital

  2. Diverticulosis • Barium Enema.

  3. Barium Enema

  4. Diverticulitis • Clinical classification • Hinchey classification • Ambrosetti classification

  5. Clinical classification(European association for endoscopic surgeons) I. Symptomatic uncomplicated disease. Fever, crampy abdominal pain, CT evidence of phlegmonous diverticulitis. II. Recurrent symptomatic disease. Recurrence of above. III. Complicated disease. (hemorrhage, abscess, perforation, purulent and fecal peritonitis, stricture, fistula, small-bowel obstruction due to postinflammatory adhesions)

  6. Hinchey classification • Stage 1 • Pericolic or mesenteric abscesses. • Stage 2 • Walled off pelvic abscess. • Stage 3 • Generalised purulent peritonitis. • Stage 4 • Generalised fecal peritonitis

  7. Ambrosetti’s CT Staging of Diverticulitis. • Mild Diverticulitis Localized sigmoid wall thickening (less than 5 mm) Inflammation of pericolic fat. • Severe Diverticulitis Abscess Extraluminal air Extraluminal contrast

  8. Complicated diverticulitis • Abscess • Purulent peritonitis • Faecal peritonitis • Colovaginal fistula • Colovesical fistula • Colocutan fistula • Stricture • Hemorrage

  9. Differential diagnosis • Appendicitis. • Inflammatory bowel disease(Crohn’s disease). • Pelvic inflammatory disease. • Tubal pregnancy. • Tuboovarian abscess. • Cystitis. • Advanced colonic cancer. • Infectious colitis. • Colorectal cancer.

  10. Diagnostic tools • Clinical symptoms. • Lab tests. • Barium enema. • Ultrasound. • MRI. • CT. • Laparoscopy.

  11. Clinical symptoms The AVOD study: Chabok A et al, British Journal of Surgery 2012

  12. WBC, CRP

  13. Computed Tomography • Diverticulas • Thickening of the bowel wall >3 mm-5mm. • Cloudy fat in the mesentery

  14. Abscess

  15. CT • Sensitivity 93%-98% • Specificity 75%-100% • Stefánsson T, Acta Radiol. 1997 Mar;38(2):313-9. • Doringer E. Crit Rev Diagn Imaging 1992; 33: 421–35 • Hulnick DH et al, Radiology,1984; 152: 491–95. • Cho KC et al, Radiology 1990; 176: 111–15. • Ambrosetti P et al Dis Colon Rectum 2000; 43: 1363–67.

  16. Barium Enema • Diverticulas • Edema • Intramural sinus tract. • Extravasated contrast material outlining an abscess cavity. • Fistula.

  17. Barium Enema • Sensitivity 0.82 (95% CI: 0.71-0.90) • Specificity 0.81 (95% CI: 0.67-0.91) Stefánsson T, Acta Radiol. 1997 Mar;38(2):313-9.

  18. Ultrasound

  19. Ultrasound • Inflamed segment. • Hypoechogenic thickening of the bowel wall (Hypertrophy of muscularis propria) • Hyperechogenic halo (Pericolitis, inflammatory fat) • Diverticulum with hyperechogenic halo. • Luminal narrowing. • Hypoperistalsis. • Pericolic abscess.

  20. Ultrasound • Operator dependent • Sensitivity 98.6% • Specificity 96.5% • Schwerk WB, Zeitschrift für Gastroenerologi 1993

  21. Ultrasound • Inflammatory target sign in the left lower quadrant, • Hyperechogenic halo and diverticula. • Highly suggestive of ACD in a symptomatic patient. • Surgeons in training showed 84% sensitivity for US diagnosis . Comparable to the results of specialists. • A. Zielke, Surgical Endoscopy 1997.

  22. US vs CT • Sensitivity • US : 92% (95% CI:80%-97%) • CT 94% (95%CI: 87%-97%) (p=0.65). • Specificity • US 90% (95%CI: 82%-95%) • CT 99% (95%CI: 90%-100%) (p=0.07). • Alternative diseases sensitivity ranged • between 33% and 78% for US and • between 50% and 100% for CT • Wytze Laméris, Eur Radiol (2008) (metatanalysis)

  23. Magnetic Resonance Imaging • Uncomplicated diverticulitis • Diverticula • Bowel wall thickening ( more than 3-5 mm) • Pericolonic fat stranding • Complicated diverticulitis • Diverticula • Bowel wall thickening more than 5 mm • Perforation, Abscess • fistula

  24. MR

  25. MR

  26. MR

  27. Laparoscopy • Acute abdomen • Acute abdomen due to diverticulitis Differentiate between purulent peritonitis and faecal peritonitis. • Recurrent diverticulitis or cronic diverticulitis to decide if the patient must be operated or not.

  28. Summary. • Lower abd pain, tenderness and raised CRP. • US ? If in doubt CT or MRI. • CT or MRI best to diagnose complications and diff diagnosis. • 6-8 weeks later colonoscopy if you want to rule out cancer.

More Related