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ACUTE DIVERTICULITIS: SAFETY AND VALUE OF CONTRAST STUDIES IN PREDICTING NEED FOR OPERATION
Author(s) -
Kourtesis George J.,
Williams Russell A.,
Wilson Samuel E.
Publication year - 1988
Publication title -
australian and new zealand journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.111
H-Index - 51
eISSN - 1445-2197
pISSN - 0004-8682
DOI - 10.1111/j.1445-2197.1988.tb00983.x
Subject(s) - medicine , diverticulitis , contrast (vision) , value (mathematics) , intensive care medicine , general surgery , artificial intelligence , statistics , mathematics , computer science
Results of treatment of 70 patients hospitalized with acute diverticulitis were analysed to determine the value of early contrast enema in management. A water‐soluble enema done during the first week of hospitalization in 48 patients showed diverticulosis with spasm (30). a leak or peridiverticulitis (16) and a normal study (two). No complications were caused by the study. Forty patients improved on medical therapy, hut four relapsed after discharge. Thirty‐four (49%) patients had urgent operation during hospitalization for the acute episode of diverticulitis. Findings on contrast enema correlated with the need for surgery during the acute phase: 13 of 16 with peridiverticulitis or a leak compared with three of 30 with diverticulosidspasm ( P < 0.001). Operations performed were: sigmoid resection and primary anastomosis (17) with covering colostomy (five), Hartmann's operation (eight), colostomy and/or drainage (seven). right hemicolectomy (two). Findings at surgery were: abscess (15), phlegmon (12), peritonitis (five) and colovesical fistula (two). It is concluded that early contrast enemas of the distal colon done with appropriate precautions are useful in confirming the diagnosis of diverticular disease: only two of 48 studies were falsely negative. A pericolic extravasation (as opposed to a small sinus tract) or abscess usually indicates need for operation, whereas the finding of diverticulosidspasm suggests a favourable outcome of conservative management.