21 Ultrasound Inflammatory target sign in the left lower quadrant, Hyperechogenic halo and diverticula.Highly suggestive of ACD in a symptomatic patient.Surgeons in training showed 84% sensitivity for US diagnosis . Comparable to the results of specialists.A. Zielke, Surgical Endoscopy 1997.
22 US vs CT Sensitivity US : 92% (95% CI:80%-97%) CT 94% (95%CI: 87%-97%) (p=0.65).SpecificityUS 90% (95%CI: 82%-95%)CT 99% (95%CI: 90%-100%) (p=0.07).Alternative diseases sensitivity rangedbetween 33% and 78% for US andbetween 50% and 100% for CTWytze Laméris, Eur Radiol (2008) (metatanalysis)
23 Magnetic Resonance Imaging Uncomplicated diverticulitisDiverticulaBowel wall thickening ( more than 3-5 mm)Pericolonic fat strandingComplicated diverticulitisBowel wall thickening more than 5 mmPerforation, Abscessfistula
27 Laparoscopy Acute abdomen Acute abdomen due to diverticulitis Differentiate between purulent peritonitis and faecal peritonitis.Recurrent diverticulitis or cronic diverticulitis to decide if the patient must be operated or not.
28 Summary. Lower abd pain, tenderness and raised CRP. US ? If in doubt CT or MRI.CT or MRI best to diagnose complications and diff diagnosis.6-8 weeks later colonoscopy if you want to rule out cancer.