Complicated Diverticulitis Rates in Acute Abdominal Cases

Abstract

Background: The location of diverticulitis, the frequency of the concomitant findings, and the severity of diverticulitis were detected in the abdominal CTs of the patients who presented to the emergency service with complaint of acute abdomen due to complicated diverticulitis. The necessity of CT evaluation was emphasized using classification. Aims: The aim of this study is to raise awareness about the fact that the abdominal CTs should be evaluated by classification in order to guide a physician encountering a patient with complicated diverticulitis who presented with acute abdomen for the first time to the correct treatment option. Study Design: The present study protocol was reviewed and approved by the Recep Tayyip Erdoğan University Local Ethics Committee (approval No. 40465587-40). Informed consent was submitted by all subjects when they were enrolled. The approval of and the permission for study from the training and research hospital management was received. The data of the patients over the age of 35 who presented to the emergency service of our hospital from 2014-2016 with the complaint of acute abdomen was retrospectively evaluated. The medical information of the patients kept in the system records was reviewed. Methods: The contrast abdominal CTs of 1000 patients were examined. 56 patients with diverticular disease were divided into two groups; non-complicated and complicated diverticulitis. The group with complicated diverticulitis was classified by two radiologists using modified Hinchey classification. The data obtained was statistically analyzed using the Pearson Chi-Square Test. Results: Diverticular disease was detected in 5.6 of 1000 patients, 2.3% of which was non-complicated, while 3.3% was complicated. Of the patients with complicated diverticulitis, 2.1% were classified as having Hinchey Ia, 0.4% Hinchey Ib, 0.2% Hinchey II, 0.3% Hinchey III, and 0.3% Hinchey IV diverticulitis. Of the patients with diverticular disease, 58.8% developed complicated diverticulitis, 18.2% of whom developed Hinchey III-IV diverticulitis requiring inpatient conservative and surgical treatment. Descenden and sigmoid colon involvement was seen primarily (60.9%). Of the six patients with possibility of surgical indication who were classified as having Hinchey III/IV diverticulitis, 100% had peritonitis with localized and pelvic abscess, 50% had perforation, and 75% had purulent fluid. Conclusion: Complicated diverticulitis can be seen in the majority of diverticulitis patients who present to the emergency service with acute abdomen. As Hinchey III/IV stages may require emergency intervention and be fatal, we are of the opinion that classification systems should be routinely used for the proper management of the treatment of the disease.

Key words: Diverticulitis, classification, Hinchey, CT

DOI: 10.7176/JSTR/5-2-19