SONOGRAPHY IN ACUTE COLONIC DIVERTICULITIS

This prospective study was designed to assess the value of high‐resolution real‐time sonography in the diagnosis of colonic diverticulitis (1). Over a 2‐yr period, 130 patients who, on the hasis of history, physical examination, and laboratory data had “diverticulitis” as part of the differential diagnosis, were entered into the study. These patients were categorized on the strength of clinical suspicion of diverticulitis as “highly suspected” (n = 28), “possible but equivocal” (n = 68), and “very unlikely” (n = 34). Fifty‐two of the patients studied had colonic diverticulitis as a final diagnosis, 42 had a definitive diagnosis other than diverticulitis; the remaining 36 patients had a “diagnosis” of nonspecific abdominal pain. Using echomorphologic criteria and the presence of tenderness on gradual compression, the authors diagnosed diverticulitis (in the 52 patients with this final diagnosis) with a sensitivity of 98.1% and a specificity of 97.5%. Positive and negative predictive values in this group of patients were 96.2% and 98.5%, respectively. This high accuracy of diagnosis was similar, irrespective of strength of clinical suspicion. Twelve of 13 tissue‐confirmed abscesses were detected by ultrasonography. Seven of these ultrasonically visible abscesses were treated by ultrasound‐guided drainage techniques to avoid surgery. The authors conclude that high‐resolution sonography with graded compression is highly sensitive and specific for the imaging diagnoses of acute colonic diverticulitis and complicating abscess.