Ultrasonography in acute diverticulitis – credit where credit is due^[1]

Abstract

Diagnosing diverticulitis implies physical and laboratory examination, cross-sectional imaging (computed tomography [CT] or ultrasonography [US]), and a classification of the type of diverticular disease. This article illustrates the role of ultrasonography in view of the recently published Guidelines on diverticular disease of the Consensus Conference of the German Societies of Gastroenterology (DGVS) and Visceral Surgery (DGAV).

The focus is to foster both sensitivity for pictorial analysis and improving practical accomplishments of US in diverticulitis.

Based on the German classification of diverticular disease (CDD), characteristic features of each type of diverticulitis are presented and commented along with possible differential diagnoses. In the literature qualified US is equipotent to qualified CT. US is frequently effective for the diagnosis and unsurpassed resolution enables detailed imaging thereby allowing one to differentiate and stratify the relevant types of diverticular disease according to the new classification.

This educational review is a guided tour through the different facettes of diverticulitis on ultrasonography thereby expanding and multiplying individual competence to more users. With expert performance, US is in the pole position for diagnosing diverticulitis, however, this does come with the price of responsibility and requires transfer of advanced standards and performance in the broad.

Zusammenfassung

Die Leitlinien-konforme Diagnose einer Divertikulitis erfordert eine körperliche Untersuchung, Laboranalysen, ein Schnittbildverfahren (Ultraschall [US] oder Computertomografie [CT]) sowie eine Klassifikation des Divertikulitis-Typs. Diese Arbeit veranschaulicht die Rolle der Sonografie im Kontext der kürzlich veröffentlichten gemeinsamen Leitlinie zur Divertikulitis/Divertikelkrankheit der Deutschen Gesellschaften für Verdauungs- und Stoffwechselkrankheiten (DGVS) sowie für Allgemein- und Viszeral-Chirurgie (DGAV). Kernpunkte dabei sind eine Schärfung der Bildanalyse und die optimierte Durchführung der Ultraschalluntersuchung bei der Divertikulitis. Basierend auf der neuen Klassifikation der Divertikelkrankheit (CDD) werden charakteristische Merkmale der Divertikulitis-Typen vorgestellt und kommentiert, wichtige Differenzialdiagnosen eingeschlossen. Die Literatur weist qualifizierten US als gleichwertig zum qualifizierten CT aus. Die Sonografie ist häufig diagnostisch ausreichend; ihre unübertroffene Auflösung erlaubt eine detaillierte Beurteilung und ermöglicht eine Stratifizierung der einzelnen Typen der Divertikelerkrankung entsprechend der CDD. Die hier vorgestellten US-Befunde veranschaulichen die verschiedenen Facetten der Divertikulitis im US und dienen damit der Vertiefung und Verbreitung der individuellen Kompetenz. In der Hand des Geübten ist US die Methode der Wahl in der Divertikulitis-Diagnostik. Das impliziert Verantwortung für den Befund, aber auch für die Weitergabe eines solchen Standards und qualifizierter Durchführung der Untersuchung in die Breite.

Key words

acute diverticulitis - diverticular disease - intestinal ultrasonography - education

Schlüsselwörter

akute Divertikulitis - Divertikelerkrankungen - Ultraschall - Fortbildung

¹ Ultrasound Obtains Pole Position for Clinical Imaging in Acute Diverticulitis. Statement of the Section Internal Medicine of the DEGUM. Ultraschall in Med. 2015; 36: 191 – 194

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