|ECR 2019 / C-1164|
|Acute Diverticulitis - CRP can safely guide the utilisation of high quality CT imaging|
The increasing incidence of colonic diverticulitis, particularly in the 45-55 year old cohort, creates clinical and financial burdens on surgical and radiological services within all colorectal departments. This appears to be an upward trend with regards to complicated disease.
The clinical and financial implications of utilising CRP as a tool to trigger or prevent CT scanning deserves further assessment. CT imaging for the diverticulitis cohort can potentially be more selectively utilised when guided by the admission CRP [figs xyz 8,9]. With a threshold as low as 50mg/L we could safely reduce the CT workload by 53% whilst ensuring we missed none of the complicated diverticulitis cases, which as a cohort tend to be overtly more clinically complex as well as having significantly greater CRP on admission. This would relieve financial pressures on institutions and service pressures on overstretched radiology departments.
CT is a powerful diagnostic tool and a guide for referral to interventional radiology for PCD of intra-abdominal collections, with the aim of controlling sepsis and potentially reducing the laparotomy rate. As such it can act as a bridge to elective surgery and may reduce the appreciable stoma rate, which is still permanent in a population of individuals [3,5]. Although the numbers were small, we found no convincing evidence from our study that laparoscopy and lavage as the primary mode of treatment was clinically beneficial as a primary treatment or as a bridge to surgery.
Further work will elucidate whether percutaneous drainage as the only intervention can effectively control sepsis to a level which negates the need for resectional surgery altogether, particularly in a young patient cohort with acute complicated diverticulitis who have an appreciable relapse rate .