Obligatory medical device diagnostics.
- Abdominal ultrasonography (ultrasound examination of abdominal organs) – diagnostic method of choice in primary and follow-up diagnosis of acute diverticulitis [guideline: S2k guideline]:
- An echo-poor, initially asymmetric wall thickening (>5 mm) with abolition of wall stratification, low deformability under pressure, and narrowing of the lumen,
- The (depending on the extrusion of the causative fecal colith (“fecal stones”) variably echo-poor presentation of the inflamed diverticulum, surrounded by
- An echogenic reticular cap (pericolic inflammatory fatty tissue reaction) and
- Occasional low-echo inflammatory pathways
- Computed tomography (CT) of the abdomen (abdominal CT) with i.v. and rectal contrast – as the method of choice; diagnostic signs include:
- Thickened wall of the colon
- Surrounding fatty tissue compacted
- Thickening of the fascia
- If necessary, acute complications such as abscesses (encapsulated accumulation of pus; about 15% of patients with acute diverticulitis) and a perforation (“perforation” of the colon).
Comparison of abdominal ultrasonography versus computed tomography: sensitivity (percentage of diseased patients in whom the disease is detected by the use of the procedure, ie, a positive finding occurs) of 100% (CT 98%); specificity (probability that actually healthy people who do not have the disease in question are also detected as healthy by the procedure) for both procedures 97%.
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics, and obligatory medical device diagnostics – for differential diagnostic clarification.
- Magnetic resonance imaging of the abdomen (abdominal MRI) – indicated as an alternative to CT, especially in younger patients and pregnant women (statements possible about wall thickening, luminal stenosis, inflammation of perisigmoid fat, abscesses, covered perforation).
- CT angiography (imaging technique in medicine that can be used to visualize blood vessels in the body) and conventional angiography (+ DSA) – in the case of active bleeding to localize diverticular hemorrhage.
- Radiographs with contrast medium (KE) [should no longer be used to diagnose diverticulitis].
- Colonoscopy (colonoscopy) – no statement about the extent of inflammation possible; Caveat (Warning): should not be done in the acute stage because of the risk of iatrogenic colonic perforation (doctor-induced “puncture” of the colon)! A planned colonoscopy should be performed after the diverticulitis has healed (usually after 4-6 weeks). Note: Since patients with acute diverticulitis have a 1.9-fold risk of colorectal cancer, a prompt colonoscopy should be performed after the acute inflammation has subsided.
