title: Preoperative staging of perforated diverticulitis by computed tomography scanning.
abstract: BACKGROUND
  Treatment of perforated diverticulitis depends on disease severity classified according to Hinchey's preoperative classification. This study assessed the accuracy of preoperative staging of perforated diverticulitis by computerized tomography (CT) scanning.
  
  
  METHODS
  All patients who presented with perforated diverticulitis between 1999 and 2009 in two teaching hospitals of Rotterdam, the Netherlands, and in addition had a preoperative CT scan within 24 h before emergency surgery were included. Two radiologists reviewed all CT scans and were asked to classify the severity of the disease according to the Hinchey classification. The CT classification was compared to Hinchey's classification at surgery.
  
  
  RESULTS
  Seventy-five patients were included, 48 of whom (64 %) were classified Hinchey 3 or 4 perforated diverticulitis during surgery. The positive predictive value of preoperative CT scanning for different stages of perforated diverticulitis ranged from 45 to 89 %, and accuracy was between 71 and 92 %. The combination of a large amount of free intra-abdominal air and fluid was strongly associated with Hinchey 3 or 4 and therefore represented a reliable indicator for required surgical treatment.
  
  
  CONCLUSIONS
  The accuracy of predicting Hinchey's classification by preoperative CT scanning is not very high. Nonetheless, free intra-abdominal air in combination with diffuse fluid is a reliable indication for surgery as it is strongly associated with perforated diverticulitis with generalized peritonitis. In 42 % of cases, Hinchey 3 perforated diverticulitis is falsely classified as Hinchey 1 or 2 by CT scanning.
authors: Department of Surgery, Maasstad Hospital, P.O. Box 9100, 3007 AC, Rotterdam, The Netherlands.
authors: M P M
authors: MP
authors: Gielens
authors: I M
authors: IM
authors: Mulder
authors: E
authors: E
authors: van der Harst
authors: M P
authors: MP
authors: Gosselink
authors: K J
authors: KJ
authors: Kraal
authors: H T
authors: HT
authors: Teng
authors: J F
authors: JF
authors: Lange
authors: J
authors: J
authors: Vermeulen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001202:Ascitic Fluid / Q000000981:diagnostic imaging; D004239:Diverticulitis, Colonic / Q000145:classification / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000145:classification / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011027:Pneumoperitoneum / Q000000981:diagnostic imaging / Q000209:etiology; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D055815:Young Adult