PURPOSE: to establish CT features and CLINICAL findings which can predict successful conservative treatment OF acute left-colonic diverticulitis (ALCD).
METHOD AND MATERIALS: We retrospectively evaluated 168 consecutive patients (86 women, 82 men, mean age 61 years) admitted in emergency for CLINICALly suspected ALCD confirmed by multidetector row CT within 24 hours. RADIOLOGICAL findings were read in consensus by two radiologists. Twenty CLINICAL and biological factors as well as 15 RADIOLOGICAL pathological findings were evaluated in view OF response to conservative treatment (success rate 82%) using univariate statistical analysis (students t-test, Chi-square, Fisher-test, p<0.05).
RESULTS: Preliminary statistical results show significant correlation with failure OF conservative treatment for the following CLINICAL parameters: steroid treatment, number OF recurrent episodes, duration OF CLINICAL symptoms before hospital admission and persistent fever or leucocytosis after 48h OF treatment. CT-findings significantly predicting failure OF conservative treatment were large sized abscesses (>3cm) OF intraperitoneal localisation. Acute diverticulitis or the sigmoid colon resulted more frequently in conservative treatment failure than diverticulitis OF the descending colon or colosigmoid junction. Neither degree nor length OF colonic wall thickening nor extension OF adjacent mesenteric inflammation showed any significant correlation with treatment failure.
CONCLUSION: Our study allows defining a certain patient collective with ALCD, which must be treated under hospital conditions in view OF a possible conservative treatment failure. The others might undergo succesful management as out-patients.
CLINICAL RELEVANCE/APPLICATION: The accurate establishment OF CT features and CLINICAL findings in ALDC allowing for successful out-patient management should lead to considerable savings OF financial and human resources.