Diagnostic Criteria for Complicated Diverticular Disease of the Colon Using Contrast-Enhanced Computed Tomography
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Despite extensive research and publications on diverticular disease of the colon (DDC), the diagnostic algorithm and treatment strategy remain subjects of ongoing debate. The incidence of DDC is steadily increasing. The age distribution of patients diagnosed with complicated and uncomplicated DDC is as follows: under 30 years – less than 1%, under 40 years – 5%, under 60 years – 30%, and over 80 years – 50-60%. Approximately 10-25% of patients develop diverticulitis, and 15% of them experience a more severe complication – perforation with peritonitis. Our study aimed to develop diagnostic criteria for complications of diverticular disease of the colon (DDC) using contrast-enhanced computed tomography (CT) for determining treatment tactics. Methodically we analyzed 128 CT scans with intravenous contrast performed on patients with various manifestations of DDC complications, who were treated at the proctology department of the Minsk Regional Clinical Hospital between January 2020 and December 2023. Bowel preparation was carried out using a special diet and laxatives containing polyethylene glycol. A risk assessment scale was developed and four risk groups were formed, to which patients were assigned depending on the number of points: 0 points - no risk, 1-3 points - low risk, 4-5 points - moderate risk, 6 or more points – high risk. According to the results of our study, we determined the extent of diverticula distribution along the segments of the colon: isolated sigmoid - 71 (55.5%), left colon - 38 (29.7%), right colon - 1 (0.8%), total involvement - 18 (14%). Establish the localization of diverticula in relation to the mesentery was established: mesenteric border – 67 (52.3%), anti-mesenteric (free) border - 23 (18%), mixed localization (mesenteric and anti-mesenteric) - 38 (29.7%). The analysis of the obtained results allowed us to determine the treatment tactics for each patient depending on the nature of the existing complications of diverticular disease of the colon. Using a diagnostic map during computed tomography with bolus contrast is key for developing diagnostic criteria for complications of diverticular colon disease. Diagnostic maps are essential for accurate diagnosis and preoperative treatment planning.
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