Preoperative CT staging in sigmoid diverticulitis--does it correlate with intraoperative and histological findings?
OBJECTIVE
This study was designed to evaluate whether the computed tomography (CT) reflects the extent of the inflammation in sigmoid diverticulitis (SD) in order to draw conclusions for selecting the appropriate treatment.


METHODS
Two hundred four patients who underwent resection for SD from January 2003 to December 2008 were included. The preoperative CT stage was compared with intraoperative and histological findings. Patients were classified into phlegmonous (Hansen-Stock IIa), abscess-forming (HS IIb), and free perforated (HS IIc) forms of SD. Patients with a recurrent type of diverticulitis were excluded.


RESULTS
In the phlegmonous type (HS IIa; n = 75), we found a correlation with the preoperative stage in 52% (intraoperative) and 56% (histological), an understaging in 12% (intraoperative) and 11% (histological), and an overstaging in 36% (intraoperative) and 33% (histological). In the abscess-forming type (HS IIb, Hinchey I/II; n = 87), we found conformity in 92% (intraoperative) and 90% (histological), understaging in 3% (intraoperative) and 0% (histological), and overstaging in 5% (intraoperative) and 10% (histological). In the presence of a free perforation (HS IIc, Hinchey III/IV; n = 42), we saw conformity in 100% (intraoperative and histological). The positive predictive value for correctly diagnosing of phlegmonous type (HS IIa), abscess-forming type (HS IIb), and free perforation (HS IIc) by CT was intraoperatively (histologically) 52% (56), 92% (90), and 100% (100), respectively.


CONCLUSIONS
The CT is one of the most accurate methods for staging in SD. However, in the phlegmonous type (HS IIa), it leads to an overestimation of the findings in every third patient. It must be clarified whether this pronounced low inflammation should really be regarded as a complicated form of SD. In contrast, the abscess-forming (HS IIb) and free perforated (HS IIc) type of complicated SD is very well reflected by CT.
Ritz
Jörg-Peter
JP
Department of General, Vascular and Thoracic Surgery, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
Lehmann
Kai S
KS
Loddenkemper
Christoph
C
Frericks
Bernd
B
Buhr
Heinz J
HJ
Holmer
Christoph
C
D018784:Abdominal Abscess / Q000145:classification / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D000667:Ampicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002481:Cellulitis / Q000145:classification / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D012809:Colon, Sigmoid / Q000473:pathology / Q000601:surgery; D004239:Diverticulitis, Colonic / Q000145:classification / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007416:Intestinal Perforation / Q000145:classification / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000145:classification / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011300:Preoperative Care; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012810:Sigmoid Diseases / Q000145:classification / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D013223:Statistics as Topic; D013407:Sulbactam / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents; D000667:Ampicillin; D013407:Sulbactam