Computed tomography predictors of progression and re-presentation in uncomplicated diverticulitis: a retrospective study at two regional Australian hospitals
DOI:
https://doi.org/10.18203/2349-2902.isj20252899Keywords:
Regional Hospital Australia, Uncomplicated diverticulitis, Complicated diverticulitis, Computed tomography, Hinchey classification, Risk stratificationAbstract
Background: Acute diverticulitis is a common presentation in Australian hospitals and is primarily assessed with computed tomography (CT). Identifying CT predictors of progression from uncomplicated to complicated diverticulitis, as well as risk factors for re-presentation, is crucial, particularly in regional hospitals with limited interventional radiology services.
Methods: This retrospective study included 20 patients with CT-confirmed uncomplicated diverticulitis (WSES Grade 0, Hinchey Stage I) from Bundaberg Base Hospital (BBH) and Hervey Bay Hospital (HBH) between January 2023 and February 2024. Outcomes assessed were progression to complicated diverticulitis and re-presentation within three months. CT features (e.g., free fluid, free air, abscess formation, wall thickening, fat stranding) and clinical variables (e.g., C-reactive protein CRP) were analyzed. Statistical tests included Fisher’s exact test and t-tests, with significance set at p<0.05.
Results: Of the 20 patients, 4 progressed to complicated diverticulitis and 16 re-presented with symptoms. Abscess formation was observed exclusively in complicated cases (3/4 vs. 0/16, p=0.003). Free fluid (75.0% vs. 25.0%, p=0.087) and free air (50.0% vs. 6.3%, p=0.081) were more prevalent in complicated cases. Pericolic fat stranding and wall thickening were common but non-specific. Elevated CRP correlated with progression (mean 200.5 vs. 64.5 mg/l, p=0.029). No clear CT predictors were identified for re-presentation, though early cases (<30 days) were likely due to non-resolution and late cases (>30 days, ≤90 days) suggested recurrence.
Conclusion: Abscess, free fluid, free air, and elevated CRP (>100 mg/l) were predictors of progression to complicated diverticulitis, with abscess reaching statistical significance. No definitive CT predictors for re-presentation were identified. Structured CT reporting and prioritization of high-risk patients for admission are particularly important in regional settings with inconsistent interventional radiology access.
Metrics
References
Peery AF, Shaukat A, Strate LL. Epidemiology, pathophysiology, and treatment of diverticulitis. Gastroenterology. 2022;162(2):512-31.
Strate LL, Morris AM. Epidemiology, pathophysiology, and treatment of diverticulitis. Gastroenterology. 2019;156(5):1282-98. DOI: https://doi.org/10.1053/j.gastro.2018.12.033
Australian Commission on Safety and Quality in Health Care. Colonoscopy clinical care standard. Sydney: ACSQHC; 2020.
Stollman N, Smalley W, Hirano I. American Gastroenterological Association Institute guideline on the management of acute diverticulitis. Gastroenterology. 2015;149(7):1944-9. DOI: https://doi.org/10.1053/j.gastro.2015.10.003
Miller G, Faulkner K, Bryant R. Diagnosis and management of acute diverticulitis: a review. Med J Aust. 2019;211(9):421-7. DOI: https://doi.org/10.5694/mja2.50276
Ambrosetti P, Becker C, Terrier F. Colonic diverticulitis: impact of imaging on surgical management-a prospective study of 542 patients. Eur Radiol. 2002;12(5):1145-9. DOI: https://doi.org/10.1007/s00330-001-1143-y
Rezapour M, Ali S, Stollman N. Diverticular disease: an update on pathogenesis and management. Gut Liver. 2018;12(2):125-32. DOI: https://doi.org/10.5009/gnl16552
Hall JF, Roberts PL, Ricciardi R, Read TE, Marcello PW, Schoetz DJ. Long-term follow-up after an initial episode of diverticulitis: what are the predictors of recurrence. Dis Colon Rectum. 2011;54(3):283-8. DOI: https://doi.org/10.1007/DCR.0b013e3182028576
van Dijk ST, Daniels L, Nio CY, Somers I, van Geloven AAW, Boermeester MA. Predictive factors on CT imaging for progression of uncomplicated into complicated acute diverticulitis. Int J Colorectal Dis. 2017;32(12):1693-8. DOI: https://doi.org/10.1007/s00384-017-2919-0
Sartelli M, Catena F, Ansaloni L, Coccolini F, Griffiths EA, Abu-Zidan FM, et al. WSES guidelines for the management of acute left-sided colonic diverticulitis. World J Emerg Surg. 2015;10:37.
Feingold D, Steele SR, Lee S, Kaiser A, Boushey R, Buie WD, et al. Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum. 2014;57(3):284-94. DOI: https://doi.org/10.1097/DCR.0000000000000075
Broderick-Villa G, Burchette RJ, Collins JC, Abbas MA, Haigh PI. Hospitalization for acute diverticulitis does not mandate routine elective colectomy. Arch Surg. 2005;140(6):576-81. DOI: https://doi.org/10.1001/archsurg.140.6.576
Brown RF, Lopez K, Smith CB, Charles A. Diverticulitis: a review. JAMA. 2022;10:234.
Laméris W, van Randen A, van Gulik TM, Busch OR, Winkelhagen J, Bossuyt PM, et al. A clinical decision rule to establish the diagnosis of acute diverticulitis at the emergency department. Dis Colon Rectum. 2010;53(6):896-904. DOI: https://doi.org/10.1007/DCR.0b013e3181d98d86
Kircher MF, Rhea JT, Kihiczak D, Novelline RA. Frequency, sensitivity, and specificity of individual CT signs of diverticulitis. AJR Am J Roentgenol. 2002;178(6):1313-8. DOI: https://doi.org/10.2214/ajr.178.6.1781313
Makela JT, Klintrup K, Takala H, Rautio T. The role of C-reactive protein in prediction of the severity of acute diverticulitis. Surg Endosc. 2015;29(11):3049-55.
Andeweg CS, Mulder IM, Felt-Bersma RJF, Verbon A, van der Wilt GJ, van Goor H, et al. Guidelines of diagnostics and treatment of acute left-sided colonic diverticulitis. Dig Surg. 2013;30(4-6):278-92. DOI: https://doi.org/10.1159/000354035
Downloads
Published
How to Cite
Issue
Section
