Imaging

Diverticulosis

Preliminary Diagnosis: Diverticulosis

I. What imaging technique is first-line for this diagnosis?

Contrast enhanced computed tomography (CECT). This includes intravenous and oral contrast, if available.

II. Describe the advantages and disadvantages of this technique for diagnosing diverticulosis.

Advantages

  • Diagnostic for diverticulosis.

  • Can show the extent of diverticulosis and any associated complications.

  • Fast and requires no bowel preparation.

Disadvantages

  • Exposure to ionizing radiation.

III. What are the contraindications for the first-line imaging technique?

  • Iodinated contrast is contraindicated in patients with renal failure.

  • CT is not recommended in early pregnancy.

IV. What alternative imaging techniques are available?

Double contrast barium enema.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing diverticulosis.

Advantages

  • Double contrast barium enema can readily show diverticular disease as well as detect polyps.

Disadvantages

  • Double contrast barium enema requires adequate bowel preparation and patient cooperation with air insufflation and rolling maneuvers during imaging.

  • Radiation exposure maybe higher in comparison to CT. It is dependent on operator.

  • Complications of diverticulosis are as easily identified.

  • Risk of bowel perforation during air insufflation.

VI. What are the contraindications for the alternative imaging techniques?

  • Patients who cannot tolerate the bowel preparation should consider CT.

  • Active bowel perforation is a contraindication.

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