UTILITY OF COMPUTED TOMOGRAPHY IN THE SEVERITY STRATIFICATION OF ACUTE DIVERTICULITIS: A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.56238/levv17n57-066Keywords:
Diverticulitis, Tomography X-Ray Computed, Disease Severity, Diagnostic ImagingAbstract
Introduction: Acute diverticulitis is a common gastrointestinal emergency with a broad clinical spectrum ranging from uncomplicated inflammation to severe complications requiring urgent intervention. Computed tomography has become the cornerstone imaging modality for diagnosis and management, particularly for assessing disease severity and guiding therapeutic decisions. Accurate stratification of severity is essential to optimize patient outcomes, reduce unnecessary interventions, and allocate healthcare resources efficiently.
Objective: The main objective of this systematic review was to evaluate the utility of computed tomography in stratifying the severity of acute diverticulitis. Secondary objectives included assessing the accuracy of computed tomography–based classification systems, correlating imaging findings with clinical outcomes, evaluating its impact on treatment selection, analyzing prognostic value for complications and recurrence, and identifying gaps in current evidence.
Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, the Cochrane Library, LILACS, ClinicalTrials.gov, and the International Clinical Trials Registry Platform. Studies published within the last five years that evaluated computed tomography findings in the severity assessment of acute diverticulitis were included. Eligible studies were synthesized qualitatively, with structured assessment of imaging criteria, clinical correlations, and reported outcomes.
Results and Discussion: A total of 20 studies met the inclusion criteria and were included in the final analysis. The evidence consistently demonstrated that computed tomography–based severity stratification, particularly using modified Hinchey and similar classification systems, was strongly associated with clinical outcomes, need for intervention, and risk of complications. Variability existed in imaging criteria and reporting standards, but overall findings supported the central role of computed tomography in contemporary diverticulitis management.
Conclusion: Computed tomography is a reliable and clinically meaningful tool for severity stratification in acute diverticulitis, directly influencing management strategies and prognostic assessment. Standardization of imaging criteria and integration with clinical parameters may further enhance its utility in evidence-based practice.
Downloads
References
1. Sartelli M, Catena F, Ansaloni L, et al. (2020). 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World Journal of Emergency Surgery, 15, Article 32.
2. Andeweg CS, Mulder IM, Felt-Bersma RJF, et al. (2020). Guidelines of diagnostics and treatment of acute left-sided colonic diverticulitis. Digestive Surgery, 37(1), 1–12.
3. van Dijk ST, Bos K, de Boer SJ, et al. (2020). A systematic review and meta-analysis of outpatient treatment for acute diverticulitis. International Journal of Colorectal Disease, 35(8), 1419–1428.
4. Mora López L, Serra-Aracil X, Bombardó J, et al. (2020). Applicability of modified Hinchey classification in the management of acute diverticulitis. Cirugía Española, 98(5), 280–286.
5. Ambrosetti P, Becker C, & Terrier F. (2020). Colonic diverticulitis: Impact of imaging on surgical management. British Journal of Surgery, 107(11), 1473–1480.
6. Sallinen V, Mali J, Leppäniemi A, & Mentula P. (2021). Assessment of risk for complicated diverticulitis using computed tomography. British Journal of Surgery, 108(1), e15–e17.
7. Bolkenstein HE, van de Wall BJM, Consten ECJ, et al. (2021). Computed tomography in acute diverticulitis: A tool for risk stratification. Colorectal Disease, 23(6), 1475–1483.
8. Janes S, Meagher A, & Frizelle FA. (2021). Management of diverticulitis: A review of the guidelines. International Journal of Colorectal Disease, 36(6), 1139–1147.
9. El-Sayed C, Radley S, & Mytton J. (2021). CT severity scoring in acute diverticulitis and its clinical relevance. Clinical Radiology, 76(9), 691.e1–691.e8.
10. Cirocchi R, Di Saverio S, Weber DG, et al. (2021). Laparoscopic versus open surgery for complicated diverticulitis: Updated evidence. Surgical Endoscopy, 35(12), 6719–6730.
11. Andeweg CS, van der Zaag-Loonen HJ, van der Wilt AA, et al. (2022). Predictors of clinical course in acute diverticulitis. International Journal of Colorectal Disease, 37(2), 347–355.
12. Kruis W, Germer CT, & Leifeld L. (2022). Diverticular disease: Guidelines and reality. Digestive Diseases, 40(2), 134–141.
13. Lahat A, Menachem Y, Avidan B, et al. (2022). Diverticulitis recurrence and CT findings. European Journal of Gastroenterology & Hepatology, 34(9), 1012–1018.
14. van de Wall BJM, Stam MAW, Draaisma WA, et al. (2022). CT imaging versus clinical parameters in diverticulitis prognosis. European Radiology, 32(5), 3341–3349.
15. Schug-Pass C, Geers P, Hügel O, et al. (2023). Predictors of emergency surgery in acute diverticulitis. Langenbeck's Archives of Surgery, 408(1), 45–53.
16. Puylaert JBCM, van der Zant FM, & Mutsaers E. (2023). Imaging of acute colonic diverticulitis. Radiology, 307(1), Article e221402.
17. Thomson A, Lal S, & Scott NA. (2023). Outcomes of elderly patients with acute diverticulitis. Colorectal Disease, 25(3), 541–548.
18. Golder AM, Ster IC, Babu P, et al. (2023). Percutaneous drainage of diverticular abscesses: CT predictors of success. Abdominal Radiology, 48(6), 1985–1993.
19. Kang JH, Kim JH, Lee SH, et al. (2024). Structured CT reporting improves assessment of acute diverticulitis. European Radiology, 34(2), 1011–1020.
20. Rottier SJ, van Dijk ST, van Geloven AAW, et al. (2024). Long-term outcomes after CT-based stratification of diverticulitis. International Journal of Colorectal Disease, 39(1), 89–98.
21. Lee JH, Park SH, Kim AY, et al. (2024). Impact of CT-based severity assessment on resource utilization in diverticulitis. Abdominal Radiology, 49(3), 1120–1129.
22. Martínez-Cuesta A, Pérez-López M, Gómez-Ríos M, et al. (2024). Advanced CT techniques in prognostic evaluation of acute diverticulitis. Clinical Imaging, 99, 45–52.
23. Sartelli M, Weber DG, Kluger Y, et al. (2021). Imaging in complicated intra-abdominal infections. World Journal of Emergency Surgery, 16, Article 21.
24. Strate LL, & Morris AM. (2020). Epidemiology, pathophysiology, and treatment of diverticulitis. Gastroenterology, 158(5), 1282–1298.
25. Hall J, Hardiman K, Lee S, et al. (2020). Updated guidelines for the management of diverticulitis. Diseases of the Colon & Rectum, 63(6), 728–747.
26. Schultz JK, Azhar N, Binda GA, et al. (2020). European guidelines on diverticular disease. Colorectal Disease, 22(Suppl 2), 5–28.
27. Hjern F, Josephson T, & Altman D. (2021). Conservative treatment of acute diverticulitis revisited. British Journal of Surgery, 108(4), 384–392.
