|ECR 2019 / C-1164|
|Acute Diverticulitis - CRP can safely guide the utilisation of high quality CT imaging|
Aims and objectives
Acute diverticulitis is the commonest emergency admission to the Lothian Colorectal Unit, the largest colorectal unit in the UK. The incidence of complicated diverticular disease, associated with abscess and/or perforation is increasing [1,2]. Surgical intervention in acute, complicated disease often results in stoma formation, which can remain permanent . Therefore, attempts to eradicate intra-abdominal collections and control sepsis as either a preparatory step to elective surgery or as a definitive mode of treatment are gaining popularity. This may be achieved by percutaneous CT guided drainage [3,4] or laparoscopy and peritoneal lavage [6,7].
However the accepted “routine” is that all diverticulitis cases undergo a CT scan at admission. Whilst this has been pivotal in the assessment of acute diverticulitis, it may result in a not insignificant cohort of patients with uncomplicated disease being imaged unnecessarily at the acute presentation.
The aim was therefore to study the pathways of management and imaging of consecutive patients admitted to our unit with acute diverticulitis over a one year period, and to assess the potential value of the biochemical marker of acute inflammation, C-reactive protein (CRP) measurement, at the time of presentation as a potential tool to guide us toward more selective CT scanning [8,9].