Practice Rational Imaging

Suspected left sided diverticulitis

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f928 (Published 27 February 2013) Cite this as: BMJ 2013;346:f928
  1. N de Korte, consultant surgeon1,
  2. W de Monyé, consultant radiologist2,
  3. H B A C Stockmann, consultant surgeon3
  1. 1Department of Surgery, Spaarne Ziekenhuis, Hoofddorp, Spaarnepoort 1, 2134 TM Hoofddorp, Netherlands
  2. 2Department of Radiology, Kennemer Gasthuis, Haarlem, Netherlands
  3. 3Department of Surgery, Kennemer Gasthuis, Haarlem, Netherlands
  1. Correspondence to: N de Korte ndekorte{at}yahoo.com

de Korte and colleagues make the case for using ultrasonography as the first investigation to confirm the diagnosis in patients with suspected diverticulitis

Learning points

  • Left sided diverticulitis can be accurately diagnosed by clinical findings and laboratory tests in only a few patients so imaging tests are usually necessary to confirm the diagnosis

  • Computed tomography and ultrasonography have similar diagnostic accuracy for uncomplicated diverticulitis, but as ultrasonography is widely available, cheap, and avoids exposure to radiation. When possible it should be the first choice of imaging to confirm the diagnosis

  • In the case of non-diagnostic or inconclusive results on ultrasonography, computed tomography should be performed as it is superior to ultrasonography in identifying an alternative diagnosis

  • In a critically ill patient, with a clear indication of infection or high fever, computed tomography should be done without delay to rule out complicated (abscess, perforation) diverticulitis and to guide treatment

A 55 year old man presented to the emergency department with a two day history of progressive pain in the left lower quadrant. On physical examination he had a temperature of 38°C and marked tenderness in the left lower quadrant and some tenderness in the suprapubic area. No rebound tenderness was present. Laboratory testing showed a C reactive protein concentration of 25 mg/L and a white cell count of 13.8 ×109/L.

What is the next investigation?

This patient is suspected of having a left sided diverticulitis. Diagnosis based solely on clinical and laboratory parameters is imperfect. The sensitivity for diagnosing acute diverticulitis on …

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