ACR Appropriateness Criteria® Left Lower Quadrant Pain-Suspected Diverticulitis.


Journal Article

This review summarizes the relevant literature regarding imaging of suspected diverticulitis as an etiology for left lower quadrant pain, and imaging of complications of acute diverticulitis. The most common cause of left lower quadrant pain in adults is acute sigmoid or descending colonic diverticulitis. Appropriate imaging triage for patients with suspected diverticulitis should address the differential diagnostic possibilities and what information is necessary to make a definitive management decision. Patients with diverticulitis may require surgery or interventional radiology procedures because of associated complications, including abscesses, fistulas, obstruction, or perforation. As a result, there has been a trend toward greater use of imaging to confirm the diagnosis of diverticulitis, evaluate the extent of disease, and detect complications before deciding on appropriate treatment. Additionally, in the era of bundled payments and minimizing health care costs, patients with acute diverticulitis are being managed on an outpatient basis and rapid diagnostic imaging at the time of initial symptoms helps to streamline and triage patients to the appropriate treatment pathway. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Full Text

Duke Authors

Cited Authors

  • Expert Panel on Gastrointestinal Imaging:, ; Galgano, SJ; McNamara, MM; Peterson, CM; Kim, DH; Fowler, KJ; Camacho, MA; Cash, BD; Chang, KJ; Feig, BW; Gage, KL; Garcia, EM; Kambadakone, AR; Levy, AD; Liu, PS; Marin, D; Moreno, C; Pietryga, JA; Smith, MP; Weinstein, S; Carucci, LR

Published Date

  • May 2019

Published In

Volume / Issue

  • 16 / 5S

Start / End Page

  • S141 - S149

PubMed ID

  • 31054740

Pubmed Central ID

  • 31054740

Electronic International Standard Serial Number (EISSN)

  • 1558-349X

Digital Object Identifier (DOI)

  • 10.1016/j.jacr.2019.02.015


  • eng

Conference Location

  • United States