How to strengthen the management of acute diverticulitis: the utility of the WSES classification-a prospective single-center observational study.

PURPOSE: This study aimed to validate the World Society for Emergent Surgery (WSES) scale for the management of acute left-sided colonic diverticulitis (ALCD). METHODS: An observational study based on a prospective database of patients with ultrasound (US) and computerized tomography (CT) confirmed ALCD was conducted at our center from April 2018 to May 2019. The primary outcome was the success rate of outpatient management. Secondary outcomes were the association between different WSES stages, clinical and analytical parameters, treatments modalities, and outcomes, and the accuracy of US for management decisions. RESULTS: A total of 230 patients were included. Outpatient management was successful in 51/53 (96.23%) cases with ALCD stage 0 and 62/72 (86.11%) patients with stage 1A. There were no differences in age (p = 0.076) or the presence of pericolic air bubbles (p = 0.06) between patients who underwent admission or outpatient management. Clinical and analytical data, treatment decisions, and outcomes showed statistically significant differences between WSES stages. In 7/12 patients with stage 2A, percutaneous drainage or emergency surgery was required. All cases with stage 2B (distant air) underwent conservative management without the need for emergency or elective surgery. The accuracy of US WSES stages for management decisions, when compared with CT, was 96.96%. CONCLUSION: The WSES classification for ALCD seemed to be valid helping clinicians in the decision-making process to select between admission or outpatient management. Differences in clinical and analytical data, elected treatments, and outcomes were found between WSES stages. The US WSES stages showed high accuracy for management decisions.

Ultrasound can differentiate complicated and noncomplicated acute colonic diverticulitis: a prospective comparative study with computed tomography.

OBJECTIVE: To prospectively assess the diagnostic value of intestinal ultrasound (US) compared to computerized tomography (CT) in differentiating uncomplicated and complicated acute colonic diverticulitis (ACD). MATERIALS AND METHODS: During a period of 14 months patients referred to the department of Radiology with clinical suspicion of ACD underwent an US examination. All confirmed US ACD diagnosis were included and subsequently underwent an emergency abdominal CT, used as gold standard. The WSES (World Society for Emergent Surgery) classification of diverticulitis was used. Diverticulitis was prospectively classified as either uncomplicated or complicated. Sensitivity, specificity, positive predictive value, and negative predictive values of US were evaluated. Before CT scan, the radiologist indicated whether they would have required or not a complementary CT scan, based on US findings. RESULTS: Of the 240 patients included in our study, 71 (29.6%) were Stage 0, 127 (53%) Stage 1A, and 42 (17.5%) were moderate-severe ACD (stages 1B, 2A, 2B, 3 and 4). The sensitivity of US for diagnosing complicated ACD was 84% and specificity of 95.8%. Most patients (24 of 27) misclassified by US as uncomplicated diverticulitis were classified on CT as stage 1A. From the 148 cases in which the radiologist considered CT unnecessary, only 3 of these revealed signs of complicated ACD on CT; none of them required emergency surgery. CONCLUSION: US is an effective technique to differentiate complicated from uncomplicated ACD. Our results suggest that US, may be a valuable alternative to CT for the initial radiologic evaluation in patients with clinical suspicion of ACD.

Polimorfismos del sistema HLA (loci A*, B* y DRB1*) en población colombiana / Polymorphisms of HLA (LOCI A*, B* and DRB1*) system in Colombian population

El objetivo de este trabajo fue determinar las frecuencias alélicas del sistema HLA-A*,B* y DRB1* en una muestra de 981 individuos de la población colombiana. El tamaño de la muestra fue depurado a partir de la base de datos del la Red Colombiana de Trasplantes de donde se tomaron finalmente 981 individuos a los cuales se les realizó el análisis estadístico por medio del programa ARLEQUIN versión 2000. Se encontró una diversidad total de 66 alelos que representan el 87/100 de la diversidad alélica mundial a nivel de los loci A*, B* y DRB1*. Se hallaron 19 alelos para el locus HLA-A*, 33 para el locus HLA-B* y 14 para el DRB1*. Los alelos HLA-A*02 y HLA-A*24 presentaron una frecuencia de 0,2696 y 0,2706 respectivamente, que corresponden al 54/100 de la muestra analizada. Los alelos HLA-B*35 y HLA-B*51 fueron los más frecuentes del loci B*: 0,1926 y 0,1314, respectivamente. Para los DRB1*, únicamente el DRB1*04 presenta una alta frecuencia: 0.238. Los restantes alelos muestran frecuencias inferiores al 12/100. Los resultados de este trabajo confirman, a nivel molecular, la diversidad genética de la población estudiada, dado que Colombia posee el 87/100 de los polimorfismos HLA (loci A*, B* y DRB1*) encontrados en el mundo.