Original Article

Acute diverticulitis: demographic, clinical and laboratory features associated with computed tomography findings in 741 patients

  1. G. F. Longstreth1,*,
  2. R. L. Iyer1,
  3. L.-H. X. Chu1,
  4. W. Chen1,
  5. L. S. Yen2,
  6. P. Hodgkins2,
  7. A. A. Kawatkar1

Article first published online: 11 SEP 2012

DOI: 10.1111/apt.12047

Issue

Alimentary Pharmacology & Therapeutics

Alimentary Pharmacology & Therapeutics

Volume 36, Issue 9, pages 886–894, November 2012

Additional Information

How to Cite

Longstreth, G. F., Iyer, R. L., Chu, L.-H. X., Chen, W., Yen, L. S., Hodgkins, P. and Kawatkar, A. A. (2012), Acute diverticulitis: demographic, clinical and laboratory features associated with computed tomography findings in 741 patients. Alimentary Pharmacology & Therapeutics, 36: 886–894. doi: 10.1111/apt.12047

Author Information

  1. 1

    Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA

  2. 2

    Global Health, Economics and Outcomes Research, Shire Development LLC, Wayne, PA, USA

* Correspondence to:
Dr G. F. Longstreth, Department of Research and Evaluation, Kaiser Permanente Southern California 100 S. Los Robles, Pasadena, CA 91101, USA.
E-mail: george.f.longstreth@kp.org

Publication History

  1. Issue published online: 3 OCT 2012
  2. Article first published online: 11 SEP 2012
  3. Manuscript Accepted: 23 AUG 2012
  4. Manuscript Revised: 15 AUG 2012
  5. Manuscript Revised: 10 AUG 2012
  6. Manuscript Received: 23 JUL 2012

Funded by

  • Shire Development LLC

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Summary

Background

Computed tomography (CT) demonstrates diverticulitis severity.

Aim

To assess demographic, clinical and leucocyte features in association with severity.

Methods

We reviewed medical records of 741 emergency department cases and in-patients with diverticulitis. CT findings were: (i) nondiagnostic; (ii) moderate (peri-colic inflammation); and (iii) severe (abscess and/or extra-luminal gas and/or contrast).

Results

Patients with severe vs. nondiagnostic/moderate findings had fewer females (42.4% vs. 58.2%, P = .004), less lower abdominal pain only (74.7% vs. 83.7%, P = .042) and more constipation (24.4% vs. 12.5%, P = .002), fever (52.2% vs. 27.0%, P < .0001), leucocytosis (81.5% vs. 55.2%, P < .0001), neutrophilia (86.2% vs. 59.0%, P < .0001), ‘bandemia’ (18.5% vs. 5.5%, P < .0001) and the triad of abdominal pain, fever and leucocytosis (46.7% vs. 19.9%, P < .0001) respectively. Severe vs. nondiagnostic/moderate findings occurred in 4.8% vs. 95.2% without fever or leucocytosis, 7.0% vs. 93.0% with fever, 12.3% vs. 87.7% with leucocytosis and 25.1% vs. 74.9% with fever and leucocytosis respectively (P < .0001). The former group (odds ratio [95% CI]) included females less often (0.45 [0.26–0.76]) and had less lower abdominal pain only (0.54 [0.29–0.99]) and more constipation (2.32 [1.27–4.23]), fever (2.13 [1.27–3.57]) and leucocytosis (2.67 [1.43–4.99]).

Conclusions

Less than 50% of severe cases have the clinical/laboratory triad of abdominal pain, fever and leucocytosis, but only 1 of 20 with pain who lack fever and leucocytosis have severe diverticulitis. Male gender, pain not limited to the lower abdomen, constipation, fever and leucocytosis are independently associated with severe diverticulitis.

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