Dharmarajan et al reported a grading system for perforated diverticulitis as seen on abdominal computed tomography (CT) scan. This can help to determine if nonoperative management can be attempted. The authors are from Washington University in St. Louis.
Patient selection: perforated diverticulitis
Exam: abdominal CT
Parameters:
(1) localized free air (pericolonic)
(2) distant free air (small if < 2 cm; large if >= 2 cm)
(3) abscess (small if < 4 cm; large if >= 4 cm)
(4) non-loculated free fluid in the peritoneal cavity
Localized Free Air
Distant Free Air
Abscess
Non-Loculated Free Fluid
Grade
present
none
none
none
1
NA
< 2 cm collections
NA
none
2
NA
NA
< 4 cm
none
2
NA
>= 2 cm collections
NA
none
3
NA
NA
>= 4 cm
none
3
NA
NA
NA
present
4
Factors that may determine how the patient is managed:
(1) CT grade
(2) physiologic status
(3) comorbidities
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