Ecografía abdominal como primera prueba radiológica en la diverticulitis aguda izquierda no complicada

  • Título abreviado Ecografía abdominal como primera prueba radiológica
    en la diverticulitis aguda
  • Abbreviated title Ultrasonography imaging
    like a first-line technique
    for diverticulitis
  • Autores LD. Juez
    D. Ramos
    J. Ocaña
    A. Centeno
    R. Arranz
    V. Vaello
    A. Ballestero
    M. Herrero
    I. Moreno
    I. Pecharromán
    JM. Fernández-Cebrián
    J. Die
  • Categoría Cirugía colorrectal
  • Fecha de recepción 29-03-2022
  • ISSN 3020-2655
  • Fecha de aceptación 17-05-2023
  • Páginas 9
  • Número 1:9

Ecografía abdominal como primera prueba radiológica en la diverticulitis aguda izquierda no complicada

Ultrasonography imaging like a first-line technique for uncomplicated left acute diverticulitis

Luz Divina Juez Sáez*, Diego Ramos Rubio*, Juan Ocaña Jiménez*, Álvaro Centeno Velasco*, Raquel Arranz JIMÉNEZ*, Víctor Vaello Jodrá*, Araceli Ballestero*, Marta Herrero**, Irene Moreno montes*, Inés Pecharromán de las Heras**, José María Fernández-Cebrián*,
Javier Die Trill*

* Servicio de Cirugía General y Aparato Digestivo. Hospital Universitario Ramón y Cajal. Madrid. España
** Servicio de Radiología. Hospital Universitario Ramón y Cajal. Madrid. España.

DOI: 10.14679/2329
Resumen:

Introducción. Para el diagnóstico de la diverticulitis aguda no complicada (DANC) es necesario una prueba de imagen. Tradicionalmente la tomografía axial computarizada (TAC) ha sido la prueba gold standard, pero cada vez hay más evidencia de que la ecografía abdominal (ECO) podría ser también tan eficaz como la TAC. Material y métodos. Se realizó un estudio observacional de cohortes retrospectivo en un hospital terciario que incluyó a todos los pacientes con diagnóstico de DANC confirmada por imagen (ya sea TAC o ECO) desde el servicio de Urgencias durante un periodo de 2 años. Los pacientes fueron designados como DANC en base a una clasificación de Hinchey modificada por nuestro centro, considerando enfermedad complicada la evidencia de absceso pericólico o intraabdominal, neumoperitoneo o peritonitis difusa. Resultados. Un total de 104 pacientes con diagnóstico de DANC se incluyeron en el estudio. El manejo ambulatorio fue exitoso en el 94,2% de los pacientes (n=97), con sólo 6 reingresos (5,8%), sin diferencias entre el grupo de TC o de ECO (p=0,09). Hubo 6 reingresos, 5 habían sido diagnosticados por TAC, y 1 por ECO. No se encontraron diferencias estadísticamente significativas en la tasa de fracaso del tratamiento ambulatorio entre los grupos (p>0,05). Conclusión. La ecografía abdominal es una técnica segura y factible que podría utilizarse como técnica de imagen de primera línea para el diagnóstico de la DANC. Además, en los casos aptos para el manejo ambulatorio, presentó un éxito de tratamiento similar y sin más reingresos que los diagnosticados por TAC
Palabras clave: Diverticulitis aguda no complicada, diagnóstico, Urgencias.

Abstract:

Introduction. An imaging test is necessary for the diagnosis of non-complicated acute diverticulitis (NCAD). Traditionally, computed tomography (CT) has been the gold standard test, but there is increasing evidence that abdominal ultrasound (US) may also be as effective as CT. Material and methods. A retrospective observational cohort study was performed in a tertiary hospital including all patients with a diagnosis of NCAD confirmed by imaging (either CT or US) from the Emergency Department over a 2-year period. Patients were designated as NCAD based on a Hinchey classification modified by our center, with evidence of pericolic or intra-abdominal abscess, pneumoperitoneum or diffuse peritonitis being considered as complicated disease. Results. A total of 104 patients with a diagnosis of NCAD were included in the study. Outpatient management was successful in 94.2% of patients (n=97), with only 6 readmissions (5.8%), with no difference between the CT or US group (p=0.09). There were 6 readmissions, 5 had been diagnosed by CT, and 1 by US. No statistically significant differences were found in the outpatient treatment failure rate between the groups (p>0.05). Conclusion. Abdominal ultrasound is a safe and feasible technique that could be used as a first-line imaging technique for the diagnosis of NCAD. Moreover, in cases suitable for outpatient management, it showed similar treatment success and no more readmissions than those diagnosed by CT.
Key words: Uncomplicated Acute Diverticulitis, Diagnosis, Emergency.

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