Additionally, abscess size and size of the inflamed diverticulum(la) may predict longer hospitalization [32,44,45]. Higher C-reactive protein, worse leukocytosis, and advanced age also may be associated with treatment failure [3]. CT can differentiate contained extraluminal air from abscess from spilled feces; this is important for clinical management and surgical decision-making. Small-volume pericolic air (<5 cm from affected segment) can be treated with medical therapy, whereas spilled feces generally requires surgical management [3]. Abscess(es) can be drained through percutaneous US- or CT-guided catheter placement; catheter placement can reduce the need for operative intervention [3,34]. CT- or CT-fluoroscopic guidance may be preferred over US guidance when the abscess(es) is deep or composed predominantly of air [21]. CT also can identify strictures and fistulas. Both often require surgical management and may occur in patients with recurrent or chronic diverticulitis [39,46]. CT Pelvis with Bladder Contrast (CT Cystography) Colovesical fistula is suspected in patients with diverticulitis and concomitant urinary tract infection, fecaluria, or pneumaturia. CT cystography is not usually helpful for the initial evaluation of colovesical fistula. Colovesical fistula can usually be diagnosed at contrast-enhanced CT alone without intracavitary contrast material based on enhancing tract(s) with or without gas extending from the colon to the bladder wall, with or without associated focal bladder wall thickening [47]. CT cystography can provide additional information regarding the size and location of the colovesical fistula in presurgical planning in some cases [48]. Fluoroscopy Contrast Enema Contrast-enhanced enema is not useful as the initial imaging test in patients with suspected diverticulitis because CT is more accurate and easier to obtain [16].
Left Lower Quadrant Pain. Additionally, abscess size and size of the inflamed diverticulum(la) may predict longer hospitalization [32,44,45]. Higher C-reactive protein, worse leukocytosis, and advanced age also may be associated with treatment failure [3]. CT can differentiate contained extraluminal air from abscess from spilled feces; this is important for clinical management and surgical decision-making. Small-volume pericolic air (<5 cm from affected segment) can be treated with medical therapy, whereas spilled feces generally requires surgical management [3]. Abscess(es) can be drained through percutaneous US- or CT-guided catheter placement; catheter placement can reduce the need for operative intervention [3,34]. CT- or CT-fluoroscopic guidance may be preferred over US guidance when the abscess(es) is deep or composed predominantly of air [21]. CT also can identify strictures and fistulas. Both often require surgical management and may occur in patients with recurrent or chronic diverticulitis [39,46]. CT Pelvis with Bladder Contrast (CT Cystography) Colovesical fistula is suspected in patients with diverticulitis and concomitant urinary tract infection, fecaluria, or pneumaturia. CT cystography is not usually helpful for the initial evaluation of colovesical fistula. Colovesical fistula can usually be diagnosed at contrast-enhanced CT alone without intracavitary contrast material based on enhancing tract(s) with or without gas extending from the colon to the bladder wall, with or without associated focal bladder wall thickening [47]. CT cystography can provide additional information regarding the size and location of the colovesical fistula in presurgical planning in some cases [48]. Fluoroscopy Contrast Enema Contrast-enhanced enema is not useful as the initial imaging test in patients with suspected diverticulitis because CT is more accurate and easier to obtain [16].