Diagnosis of acute colonic diverticulitis: comparison of barium enema and CT.

The contrast enema and CT studies in 102 patients with a clinical diagnosis (41%) or surgically confirmed (59%) diagnosis of colonic diverticulitis were reviewed retrospectively to determine the sensitivity of the two techniques. Combined results from all patients showed that the contrast enema was correct in 77% of patients. The contrast enema was falsely negative in 15% and was indeterminate in 7%. The CT examination was diagnostic in 41%, consistent with the diagnosis of diverticulitis in 38%, and falsely negative in 21% of patients. Both CT and contrast enemas were more accurate in patients with severe disease requiring surgery. No complications occurred from 109 enemas performed. Patient management was altered in only one patient as a result of the additional information provided by CT. The contrast enema should remain the initial and routine examination for the evaluation of patients with suspected diverticulitis. CT should be reserved for patients who are unable to have an adequate contrast enema, those with suspected distant or diffuse abdominal abscess, those who are unresponsive to medical therapy, and those who are candidates for percutaneous drainage.