The diagnostic criteria for right colonic diverticulitis: prospective evaluation of 100 patients.

OBJECTIVE

In this study, we evaluate prospective diagnostic criteria and propose a clinical scoring system for the evaluation of patients suspected to have right colonic diverticulitis (RCD) prospectively.

METHODS

One hundred adult patients, who were clinically suspected to have appendicitis or RCD, and in whom we were not able to preoperatively rule out appendicitis, were examined prospectively. Patients were scored upon clinical presentation based on major diagnostic criteria included (1) no migration pain to the right lower quadrant; (2) a leukocyte count <10,000/mm(3); (3) lateralized abdominal pain, and (4) a history of right colonic diverticulum (two points each). Minor diagnostic criteria (one point each) included (1) a history of right lower quadrant abdominal pain; (2) no symptoms of nausea or vomiting; (3) symptoms of constipation or diarrhea, and (4) abdominal pain for at least seven days. For patients in whom the diagnostic score exceeded two points, a contrast enhanced computed tomography (CT) scan of the abdomen was performed.

RESULTS

Thirteen patients had a final diagnosis of RCD. These diagnostic criteria demonstrated a sensitivity of 85%, a specificity of 68%, a positive predictive value of 28%, a negative predictive value of 97%, and a diagnostic accuracy of 70%. Among the 38 patients examined with CT, diagnoses for acute diverticulitis included nine true positives, 26 true negatives, two false positives, and one false negative.

CONCLUSIONS

Performing CT scans after application of these diagnostic criteria gave a superior preoperative diagnostic rate for patients with RCD.