Intestinal Ultrasonography in the Diagnosis and Management of Colonic Diverticular Disease

Diverticula of the colon and their symptomatic manifestations, including acute diverticulitis (AD), are frequent complaints and the cause of an increasing burden of ambulatory visits, diagnostic procedures, and hospital admissions. Endoscopic and radiologic diagnostic procedures have a well-known role in the diagnosis and management of the disease, but recently intestinal ultrasonography has been proposed as a complementary tool in the diagnosis and follow-up of diverticular disease. This review shows the main sonographic features of diverticula and discusses the potential role of ultrasound in suggesting the presence of symptomatic uncomplicated diverticular disease of the colon. Moreover, the sonographic features of AD, diagnostic accuracy, advantages, and limitations of the technique will be discussed. We place special emphasis on the present role of intestinal ultrasonography in patients with suspected AD. Owing to its high sensitivity and high positive predictive value in assessing AD, intestinal ultrasound is currently suggested by some European national consensus guidelines as the first-line examination in this setting. In fact, to minimize false-negative findings and avoid unnecessary radiation exposure in patients with suspected AD, intestinal ultrasound might be used as the first-line examination in a sequential diagnostic strategy, followed by computed tomography only in the case of negative or inconclusive findings.