Clinical Application of Wses 2020 for the Evaluation of Acute Colonic Diverticulitis

Abstract

Purpose: To describe the computed tomography (CT) findings of acute colonic diverticulitis (ACD), and to evaluate its complications by using the World Society of Emergency Surgery (WSES) 2020 guideline.
Methods: Data of 70 patients with ACD treated at Hue University of Medicine and Pharmacy Hospital and Hue Central Hospital from 1/2022 to 8/2023 were analyzed. Diagnosis of CD was mainly based on CT while endoscopy and/or surgery were required if CT findings were inconclusive. Clinical manifestations, blood tests, CT findings and treatment methods were documented. Multivariate logistic regression model was run to ascertain predictors of complications of ACD.
Results: The median age was 44 (range, 35-55.3) years old, male/female ratio was 2.68, 80% of ACD was right-sided, and 94.3% of patients had diverticulosis, On CT, 100% of ACD showed fat stranding, 85.7%
colon wall thickening (in which 90% was circumferential thickening), 24.3% pericolic air bubbles, 31.4% pericolic fluid. Abscess formation was seen in 11.4%, abdominal free air in 5.7%, diffuse abdominal fluid in 8.6%, and fistula in 2.9% of cases. According to WSES 2020, the incidence of uncomplicated (stage 0) ACD was 52.9%; and complicated ACD stages 1A, 1B, 2A, 2B, 3, and 4 were 27.1%, 4.3%, 7.1%, 0%, 2.9%, and 5.7%, respectively. Factors related to complications of ACD were smoking, digestive disorders, rebound tenderness, leukocytosis, elevated NEU, CRP and CT findings including loss of diverticular wall continuity, and length of colon wall thickening. Multivariable regression analysis showed that CRP was an independent predictor of ACD complication (OR 1.016; 95% CI 1.002-1.031; p = 0.028). The cut-off value of CRP for prediction was 89.9 mg/L with sensitivity of 69.7%, specificity of 80.6%, area under the curve of 0.797, p < 0.001.
Conclusion: Right-sided ACD is more predominant. Colonic diverticulosis, fat stranding, circumferential colonic wall thickening were common CT findings. The majority of ACD patients were in stages 0 and
1A according to WSES 2020. CRP level >89.9 mg/L was an independent predictor of complications. In patients with suspected ACD who had CRP >89.9 mg/L, CT should be indicated for timely diagnosis and detection of complication.