Surgical management in acute diverticulitis and its association with multi-detector CT, modified Hinchey classification, and clinical parameters

Purpose To assess whether CT findings, clinical parameters, and modified Hinchey classification are predictive of management outcomes of patients with acute diverticulitis. Materials and methods Data were accrued between January 2014 and December 2015. A total of 301 adult subjects were identified f...

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Bibliographic Details
Published in:Abdominal imaging 2018-08, Vol.43 (8), p.2060-2065
Main Authors: Bates, David D. B., Fernandez, Marina Bernal, Ponchiardi, Cecilia, von Plato, Michael, Teich, Joshua P., Narsule, Chaitan, Anderson, Stephan W., Gupta, Avneesh, LeBedis, Christina A.
Format: Article
Language:English
Subjects:
Abscesses
Blood pressure
Classification
Computed tomography
Fistulae
Gastroenterology
Hepatology
Imaging
Intestinal obstruction
Intestine
Management
Medicine
Medicine & Public Health
Parameter modification
Patients
Radiology
Surgery
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Summary:Purpose To assess whether CT findings, clinical parameters, and modified Hinchey classification are predictive of management outcomes of patients with acute diverticulitis. Materials and methods Data were accrued between January 2014 and December 2015. A total of 301 adult subjects were identified from radiology reports, of which six who did not met the inclusion criteria were excluded, thus yielding 295 subjects. Subjects were 43.1% ( n  = 127) male and 56.9% female ( n  = 168), with mean age 51.9 years (range 18–90). Two independent abdominal radiologists reviewed all scans; imaging features and a modified Hinchey classification were scored. Descriptive statistics compared the relationships between imaging findings, clinical parameters obtained from medical record review, and modified Hinchey classification with management outcomes. Results CT findings associated with surgical management include the presence of a pericolonic fluid collection (36.8% vs. 8.2%, P  = 0.0001), colonic fistula (13.2% vs. 0.4%, P  = 0.0002), extraluminal air (26.4% vs. 9.3%, P  = 0.0052), bowel obstruction (5.2% vs. 0.0%, P  = 0.0162), and a modified Hinchey score of Ib or higher (55.3% vs. 11.7%, P  = 0.0001). Slightly lower systolic blood pressure was also associated with operative management (137.2 mmHg vs. 128.2 mmHg, P  = 0.0220). Conclusion Specific CT imaging features and modified Hinchey classification are associated with subsequent surgical management in patients with acute diverticulitis.
ISSN:2366-004X
2366-0058
DOI:10.1007/s00261-017-1422-y