CT and Clinical Features of Acute Diverticulitis
CT and Clinical Features of Acute Diverticulitis
Objective: On the basis of our experience in recent years, we hypothesized that acute diverticulitis occurs more frequently in young adult patients (age, ≤ 50 years) now than previously recognized. We reviewed the CT findings, clinical features, and demographic data of a cohort of patients who presented with acute diverticulitis at an urban U.S. academic medical center.
Materials and Methods: We used our hospital and radiology databases to identify 104 adult patients with both CT and clinical diagnoses of acute diverticulitis. Clinical parameters recorded included age, sex, ethnicity, in- or outpatient management, and therapy (medical treatment, percutaneous drainage, or surgery). CT studies were evaluated for the site of diverticulitis; associated complications; and the presence of abdominal obesity, as determined by measurement of sagittal abdominal diameter.
Results: The study group was composed of 55 men and 49 women (age range, 22-88 years; mean age, 52.2 years; median age, 49.0 years). Fifty-six (53.8%) were 50 years old or younger, and 22 were 40 years old or younger. Forty-one complications were noted in 38 patients (36%). There was no significant age difference between the ≤ 50 and > 50 years old age groups for hospital admission (90 patients, 86.5%), medical therapy (76, 73.1%), or surgery or percutaneous abscess drainage (28, 26.9%). Abdominal obesity measured by sagittal abdominal diameter was present in 48 (85.7%) and 37 (77%) of the ≤ 50 and > 50 years old age groups, respectively. The mean sagittal abdominal diameter for patients ≤ 50 years old (27.0 cm) was greater than that for patients > 50 years old (25.6 cm) (p = 0.05).
Conclusion: In this urban population, acute diverticulitis occurred more frequently in patients 20-50 years old than previously recognized. This group had significantly greater abdominal obesity than the older group. Severe disease requiring hospital admission, surgery, or percutaneous drainage (or both surgery and percutaneous drainage) was common in all age groups.
Colonic diverticulosis is etiologically related to a chronic low-fiber diet and is usually considered to be a disease that affects patients older than 50 years. The evolution of diverticulosis has coincided with the increasing refinement of cereals by the food industry, and diverticulosis is more prevalent in countries with a high degree of industrialization and a generally low intake of dietary fiber. Diverticulosis has been considered a rare condition in patients younger than 30 years old and is thought to affect approximately 75% of Americans more than 80 years old. Previous estimates of the percentage of patients with diverticular disease who are younger than 40 years old range from 2% to 5%.
Acute diverticulitis is the most common complication of colonic diverticulosis and is one of the most frequently encountered acute diseases of the colon. It begins as a localized intramural infection in a segment affected by diverticulosis, with subsequent development of localized pericolic inflammation. Colonic perforation, abscess formation, or generalized peritonitis may occur. Colonic strictures and fistulas to other organs are other important complications. Serious complications are more likely if acute diverticulitis is initially unrecognized or misdiagnosed.
Acute diverticulitis traditionally has been considered a disease of patients more than 50 years old by many authorities. It has been considered a rare diagnosis in a young adult presenting with abdominal pain, with few reports in the published literature. In one report, acute diverticulitis was considered more aggressive in younger patients than in older adults.
Abdominopelvic CT has become the imaging test of choice for the diagnosis of suspected acute diverticulitis [5, 6, 11, 13]. On the basis of our observations in recent years, we hypothesized that in our urban setting, acute diverticulitis occurs more frequently in younger and obese adult patients than has been recognized previously. Accordingly, we reviewed the CT findings, clinical features, and demographic data of a cohort of patients who presented with acute diverticulitis at our urban U.S. academic medical center.
Abstract and Introduction
Abstract
Objective: On the basis of our experience in recent years, we hypothesized that acute diverticulitis occurs more frequently in young adult patients (age, ≤ 50 years) now than previously recognized. We reviewed the CT findings, clinical features, and demographic data of a cohort of patients who presented with acute diverticulitis at an urban U.S. academic medical center.
Materials and Methods: We used our hospital and radiology databases to identify 104 adult patients with both CT and clinical diagnoses of acute diverticulitis. Clinical parameters recorded included age, sex, ethnicity, in- or outpatient management, and therapy (medical treatment, percutaneous drainage, or surgery). CT studies were evaluated for the site of diverticulitis; associated complications; and the presence of abdominal obesity, as determined by measurement of sagittal abdominal diameter.
Results: The study group was composed of 55 men and 49 women (age range, 22-88 years; mean age, 52.2 years; median age, 49.0 years). Fifty-six (53.8%) were 50 years old or younger, and 22 were 40 years old or younger. Forty-one complications were noted in 38 patients (36%). There was no significant age difference between the ≤ 50 and > 50 years old age groups for hospital admission (90 patients, 86.5%), medical therapy (76, 73.1%), or surgery or percutaneous abscess drainage (28, 26.9%). Abdominal obesity measured by sagittal abdominal diameter was present in 48 (85.7%) and 37 (77%) of the ≤ 50 and > 50 years old age groups, respectively. The mean sagittal abdominal diameter for patients ≤ 50 years old (27.0 cm) was greater than that for patients > 50 years old (25.6 cm) (p = 0.05).
Conclusion: In this urban population, acute diverticulitis occurred more frequently in patients 20-50 years old than previously recognized. This group had significantly greater abdominal obesity than the older group. Severe disease requiring hospital admission, surgery, or percutaneous drainage (or both surgery and percutaneous drainage) was common in all age groups.
Introduction
Colonic diverticulosis is etiologically related to a chronic low-fiber diet and is usually considered to be a disease that affects patients older than 50 years. The evolution of diverticulosis has coincided with the increasing refinement of cereals by the food industry, and diverticulosis is more prevalent in countries with a high degree of industrialization and a generally low intake of dietary fiber. Diverticulosis has been considered a rare condition in patients younger than 30 years old and is thought to affect approximately 75% of Americans more than 80 years old. Previous estimates of the percentage of patients with diverticular disease who are younger than 40 years old range from 2% to 5%.
Acute diverticulitis is the most common complication of colonic diverticulosis and is one of the most frequently encountered acute diseases of the colon. It begins as a localized intramural infection in a segment affected by diverticulosis, with subsequent development of localized pericolic inflammation. Colonic perforation, abscess formation, or generalized peritonitis may occur. Colonic strictures and fistulas to other organs are other important complications. Serious complications are more likely if acute diverticulitis is initially unrecognized or misdiagnosed.
Acute diverticulitis traditionally has been considered a disease of patients more than 50 years old by many authorities. It has been considered a rare diagnosis in a young adult presenting with abdominal pain, with few reports in the published literature. In one report, acute diverticulitis was considered more aggressive in younger patients than in older adults.
Abdominopelvic CT has become the imaging test of choice for the diagnosis of suspected acute diverticulitis [5, 6, 11, 13]. On the basis of our observations in recent years, we hypothesized that in our urban setting, acute diverticulitis occurs more frequently in younger and obese adult patients than has been recognized previously. Accordingly, we reviewed the CT findings, clinical features, and demographic data of a cohort of patients who presented with acute diverticulitis at our urban U.S. academic medical center.
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