THE ROLE OF SPIRAL COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF INFLAMMATORY COMPLICATIONS OF DIVERTICULAR DISEASE OF THE COLON

Abstract. In recent decades, there has been a trend towards a steady increase in the incidence of diverticular disease. Accurate diagnosis of diverticular disease and, especially, its complications, based only on the clinical picture of the disease is impossible in most cases; for this purpose, a number of diagnostic methods are used in clinical practice, such as irrigoscopy, colonoscopy, transabdominal ultrasound, spiral computed tomography and magnetic resonance computed tomography. The aim of the study is to study the possibilities of spiral computed tomography in the diagnosis of complications of diverticular disease of the colon. Materials and methods of the study. The data of full-text publications obtained as a result of a literature search in the Scopus and PubMed databases, which were devoted to the role of spiral computed tomography in the diagnosis of inflammatory complications of diverticular disease of the colon, were analyzed and systematized. Results and their discussion. Currently, spiral computed tomography is considered by most authors as the “gold standard” in the diagnosis of acute inflammatory complications of diverticular disease of the colon, and according to the recommendations of the European Society of Coloproctology: guidelines for the management of diverticular disease of the colon, it is recommended as a first-line study for suspected diverticulitis (evidence level 2, strong recommendation). CT diagnostics of acute inflammatory complications of diverticular disease is based on the assessment of a number of important parameters and symptoms: thickening of the intestinal wall, the condition of the paracolic tissue (presence of compaction, fluid, gas, abscess), the presence of diverticula, the condition of diverticula (presence of coprolites, exudate in the lumen, destroyed diverticulum or not, incomplete internal fistulas, paraintestinal cavities), the presence of remote abscesses, the presence of free gas and free fluid in the abdominal cavity. Most often, there is a need for differential diagnosis with malignant neoplasms of the colon. It is believed that the inflammatory process in diverticular disease is characterized by the presence of unchanged and inflammatory diverticula, less pronounced thickening of the intestinal wall and a longer lesion length (5-10 cm or more), the presence of infiltrative changes in the paracolic tissue, abscess and/ or small lymph nodes. Conclusions. Thus, it was established that there is no consensus on the method of performing CT in various complications of diverticular disease: to perform or not retrograde contrast of the colon; to use water or a water-soluble contrast agent for these purposes; to conduct a study of the entire colon or only the area of interest. It is necessary to continue the search and development of diagnostic criteria for assessing the severity of the inflammatory process in the colon, as well as the differentiation of acute and chronic inflammation in diverticular disease.