Use of CT Imaging in Acute Diverticulitis

Background: Acute colonic diverticulitis is generally considered to be a clinical diagnosis, however the use of CT (computed tomography) imaging in diverticulitis is becoming more common to exclude complicated diverticulitis. Objectives: To assess the use of CT imaging in the acute presentation of suspected colonic diverticulitis and whether clinical management was altered depending on imaging findings. Methods: Retrospective audit of all patients admitted to Flinders Medical Centre with a clinical diagnosis of acute colonic diverticulitis in ED or following investigation with CT between July 2011 and February 2012. Results: A total of 79 patients were suspected of having diverticulitis. 57 (72.2%) patients were confirmed to have diverticulitis following imaging of which 46 (80.7%) patients had simple diverticulitis and 11 (19.3%) patients had complicated diverticulitis (perforation n = 7 [12.3%]; abscess n = 4 [7.0%]). Overall only 6.3% of patients required radiological or surgical management for their presentation. Conclusions: There is an overuse of CT in the investigation of acute diverticulitis with limited change in clinical management as only 6.3% of patients required surgical or radiological intervention. We suggest medical management with intravenous antibiotics and bowel rest with imaging indicated after 72 hours if no clinical improvement (or earlier if warranted by the clinical status).