IV contrast material is commonly used to improve the characterization and detection of subtle bowel wall abnormalities and complications of diverticulitis (eg, abscess) [2,29]. However, for most patients, IV or intracavitary contrast material is not necessary for the diagnosis of diverticulitis [35,36]. Left Lower Quadrant Pain CT may also help predict which patients are likely to experience recurrent diverticulitis and thereby augment triage between surveillance and operative management [39]. Colonic wall thickness at the site of diverticulitis and extent of diverticulitis-related complication may predict recurrent diverticulitis. Dickerson et al [39] showed that patients with colonic wall thicknesses <9 mm had a 19% recurrence risk at 1 year compared with a 40% recurrence if the wall thickness was >15 mm. Numerous CT classification systems for diverticulitis have been proposed but none are widely integrated into clinical practice. For example, the Hinchey classification uses CT findings to differentiate between uncomplicated and complicated disease [29,40,41]. Endoscopic classification systems for predicting occurrence, recurrence, and need for surgery are undergoing validation. In patients requiring colonoscopy for colon cancer screening, CT colonography has been proposed as an alternative to colonoscopy [16,42]. Fluoroscopic Contrast-Enhanced 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]. Because diverticulitis is mainly an extramucosal process, and contrast enema shows only the secondary effects of inflammation on the colon, the evaluation of extraluminal abnormalities, such as abscesses and pericolonic fat inflammation, is limited. Contrast-enhanced enema can be used to assess for complications of diverticulitis (eg, fistula) and for presurgical planning before colonic resection (ie, assess length of stricture and colonic motility) [16].
Left Lower Quadrant Pain. IV contrast material is commonly used to improve the characterization and detection of subtle bowel wall abnormalities and complications of diverticulitis (eg, abscess) [2,29]. However, for most patients, IV or intracavitary contrast material is not necessary for the diagnosis of diverticulitis [35,36]. Left Lower Quadrant Pain CT may also help predict which patients are likely to experience recurrent diverticulitis and thereby augment triage between surveillance and operative management [39]. Colonic wall thickness at the site of diverticulitis and extent of diverticulitis-related complication may predict recurrent diverticulitis. Dickerson et al [39] showed that patients with colonic wall thicknesses <9 mm had a 19% recurrence risk at 1 year compared with a 40% recurrence if the wall thickness was >15 mm. Numerous CT classification systems for diverticulitis have been proposed but none are widely integrated into clinical practice. For example, the Hinchey classification uses CT findings to differentiate between uncomplicated and complicated disease [29,40,41]. Endoscopic classification systems for predicting occurrence, recurrence, and need for surgery are undergoing validation. In patients requiring colonoscopy for colon cancer screening, CT colonography has been proposed as an alternative to colonoscopy [16,42]. Fluoroscopic Contrast-Enhanced 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]. Because diverticulitis is mainly an extramucosal process, and contrast enema shows only the secondary effects of inflammation on the colon, the evaluation of extraluminal abnormalities, such as abscesses and pericolonic fat inflammation, is limited. Contrast-enhanced enema can be used to assess for complications of diverticulitis (eg, fistula) and for presurgical planning before colonic resection (ie, assess length of stricture and colonic motility) [16].