DOI: 10.25881/20728255_2021_16_3_25

Authors

Levchuk A.L.1, Abdullaev E.G.2, Abdullaev A.E.2

1 Pirogov National Medical and Surgical Center, Moscow

2 Vladimir City Emergency Hospital, Vladimir

Abstract

Colonic diverticular disease (CDD) is associated with a high rate of prevalence in the elderly as well as a high rate of mortality due to its complications. Mortality rates among patients undergoing emergency surgery can be as high as 9.78–10.64% and among those undergoing elective procedures such rates are significantly lower at 0.5–1.93%. Approaches to the diagnosis and treatment of CDD are currently changing. Following methods are used in the diagnosis of CDD: abdominal X-ray, colonoscopy, barium enema, computed tomography (CT), ultrasonography (USG), and magnetic resonance imaging (MRI). The significance of choice of optimal treatment modality stems from the fact that the incidence of complicated CDD is constantly rising to the extent that CDD today is called the disease of the developed civilization.

The aim of this study was to optimize the diagnosis of complicated CDD.

Materials and Methods. We have an experience of managing 743 CDD patients, who were admitted to Vladimir City Emergency Hospital from 2015 to 2020. All patients were admitted emergently.

Results. Better outcomes were seen in the following categories of patients: those admitted within the first 24 hours from the beginning of symptoms, those with first episode, and those with no complications. Peritoneal signs were positive in 23 (3%), negative in 605 (81.4%), and unclear in 115 (15.4%) cases. In 124 (16.6%) patients pericolic inflammatory mass was found at diagnosis. The mean size of the mass was 15.8±1.5-2 (11–18) cm. In 248 patients (33.3%) abdominal USG revealed signs of acute diverticulitis. Paracolic abscess was found in 110 patients (14.8%). Of these, radiology-guided percutaneous drainage of the abscess was performed in 72 patients (65.4%). In 18 cases (2.4%), traces of free fluid was found in the left mesogastrium and left iliac fossa. In 14 cases (1.8%), free fluid with dispersed suspension was visualized in all quadrants of the abdominal cavity. At laparoscopy, pericolic inflammatory mass was found in 75 (10%), diffuse peritonitis in 24 (3.2%), and generalized peritonitis in 16 patients (2.1%).

Barium enema was performed in 524 (70.5%) patients. Post-inflammatory stricture of the sigmoid colon was found in 28 (3.7%) patients. Enterocolic fistulas were revealed in 15 cases (2.8%). Abdominal CT scan was performed in 317 (42.2%) patients. The sensitivity and specificity of CT scan were found to be 93.3 % and 91.8%, respectively. The sensitivity and specificity of abdominal MRI were found to be 91.2% and 89.8%, respectively. Colonoscopy was performed in 115 (15.4%) cases. In 23 (20%) cases of those, indications for colonoscopy were urgent. In 13 (56.5%) of those 23 cases, an inflamed diverticulum of the sigmoid colon was found to be the source of bleeding. In 5 (20%) cases, the source of bleeding was sigmoid cancer. The sensitivity and specificity of the method were found to be 87% and 98.8%, respectively.

Keywords: colonic diverticular disease, severity, diagnosis of the complications of CDD.

References

1. Belov DM, Zarodnyuk IV, Mikhalchenko VA. Computed tomography diagnostics of inflammatory complications of colon diverticulitis (review). Coloproctology. 2016; (№4): 60-68. (In Russ).

2. Butorova LI. Diverticular disease of the colon: clinical forms, diagnosis and treatment: a manual for doctors. Moscow: 4TE Art; 2011. (In Russ).

3. Zarodnyuk IV, Zhuchenko AP, Moskalev AI, Bolikhov KV. Radiological diagnostics of chronic inflammatory complications of diverticular colon disease. Coloproctology. 2004; №3(9): 15-20. (In Russ).

4. Ivashkin VT, Shelygin YuA, Achkasov SI, Vasilyev SV, Grigoryev YeG, Dudka VV, Zhukov BN, Karpukhin OYu, Kuzminov AM, Kulikovsky VF, Lapina TL, Lakhin AV, Mayev IV, Moskalev AI, Muravyev AV, Polovinkin VV, Poluektova YeA, Stoyko YuM, Timerbulatov VM, Trukhmanov AS, Frolov SA, Chibisov GI, Shifrin OS, Sheptulin AA, Khalif IL, Efron AG, Yanovoy VV. Diagnostics and treatment of diverticular disease of the colon: guidelines of the Russian gastroenterological Association and Russian Association of Coloproctology. 2016; 26(1): 65-80 (In Russ).

5. Okhotnikov OI, Yakovleva MV, Shevchenko NI, Grigoriyev SN, Pakhomov YI. X-ray-surgery of diverticular disease complicated by abscess formation. Surgery. N.I. Pirogov Journal. 2018; 6: 35-40 (In Russ).

6. Pomazkin IV, Khodakov VV. Long-term results of surgical treatment of diverticular colon disease. Vestn Khir Im N.I. Grek. 2016; 176(2): 101-104 (In Russ).

7. Recommendations of the Russian Gastroenterological Association and the Association of Coloproctologists of Russia for the diagnosis and treatment of adult patients with diverticular colon disease. Russian Journal of Gastroenterology, Hepatology and Coloproctology. 2017; 1(26): 65-80. (In Russ).

8. Trubacheva YuL, Orlova LP, Moskalev AI, Skrydlevsky SN, Belov DM, Shakhmatov DG, Achkasov SI. Ultrasound diagnosis of chronic parabolic infiltrate in diverticular colon disease Surgery. N.I. Pirogov Journal. 2020; 9: 14-19. (In Russ). doi: 10.17116/hirurgia202009114.

9. Shelygin YuA, Achkasov SI, Blagodarny LA, et al. Clinical guidelines for the diagnosis and treatment of adult patients with diverticular colon disease. Moscow; 2013. Р.5 (In Russ).

10. Anaya D, Flum D. Risk of emergency colectomy and colostomy in patients with diverticular disease. Arch. Surg. 2005; 140: 681-685.

11. Etzioni DA, Mack TM, Beart RW, et al. Diverticulitis in the United States: 1998–2005. Changing patterns of disease and treatment. Ann Surg. 2009; 249(2): 2-7.

12. Haas JM, Singh M, Vakil N. Mortality and complications following surgery for diverticulitis: Systematic review and meta-analysis. United European Gastroenterol J. 2016; 4(5): 706-713.

13. Humes DJ. Changing Epidemiology: Does It Increase Our Understanding? Dig Dis. 2012; 30: 6–11.

14. King WC, Shuaib W, Vijayasarathi A, Fajardo CG, Cabrera WE, Costa JL. Benefits of sonography in diagnosing suspected uncomplicated acute diverticulitis. J Ultrasound Med. 2015; 34(1): 53-58. doi: 10.7863/ultra.34.1.53.

15. Milasavljevic T, Brandimarte G, Stollman N, Barbara G, Lahat A, Scarpignato C, Lanas A, Papa V, Tursi A, Nardone G. Course of the diverticular disease: What is changing? J Gastrointestin Liver Dis. 2019; 28(4): 11-15. doi: 10.15403/jgld-552.

16. Moreno A, Willie-Jorgensen P. Long-term outcome in 445 patients after diagnosis of diverticular disease. Colorectal. Dis. 2007; Vol. 9: 464–468.

17. Pittet O, Kotzampassakis N, Schmidt S, et al. Recurrent left colonic episodes: more severe than the initial diverticulitis? World J Surg. 2009; 33(3): 547-552.

18. Štimac D, Nardone G, Mazzari A, Crucitti A, Maconi G, Elisei W, Violi A, Tursi A, Di Mario F. What is new in diagnosing diverticular disease. J Gastrointestin Liver Dis. 2019; 28(4): 17-21. doi: 10.15403/jgld-553.

19. Tursi A, Brandimarte G, Di Mario F, Elisei W, Scarpignato C, Picchio M. Prognostic Role of the Endoscopic Classification «DICA». J Clin Gastroenterol. 2016; 50(1): 16-19. doi: 10.1097/mcg.0000000000000656.

For citation

Levchuk A.L., Abdullaev E.G., Abdullaev A.E. Diagnosis of acute diverticulitis of the colon and its complications in surgical practice. Bulletin of Pirogov National Medical & Surgical Center. 2021;3(16):25-32. (In Russ.) https://doi.org/10.25881/20728255_2021_16_3_25