Assessment of Sigmoidal Artery and Vein Diameters as Predictive Markers for Complications in Acute Sigmoid Diverticulitis: A Retrospective Observational Analysis

Assessment of Sigmoidal Artery and Vein Diameters as Predictive Markers for Complications in Acute Sigmoid Diverticulitis: A Retrospective Observational Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of Sigmoidal Artery and Vein Diameters as Predictive Markers for Complications in Acute Sigmoid Diverticulitis: A Retrospective Observational Analysis İsmail SEZİKLİ, Nurdan FİDAN, Ramazan TOPCU, Veysel Barış TURHAN, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5493445/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Acute sigmoid diverticulitis is a common inflammatory condition that can progress to severe complications such as abscess formation, fistulas, and perforation. While computed tomography (CT) is the gold standard for diagnosis, it offers limited prognostic information. Emerging evidence suggests that vascular changes in the sigmoidal arteries and veins may correlate with disease severity and serve as predictive markers for complications. Material/Methods This retrospective study analyzed 160 patients with confirmed acute sigmoid diverticulitis between May 2018 and May 2023. Patients were divided into two groups based on the presence of complications using the modified Hinchey classification: Group 1 (uncomplicated diverticulitis) and Group 2 (complicated diverticulitis). Vascular diameters were measured using contrast-enhanced CT scans, focusing on the sigmoidal arteries and veins. The study assessed the relationship between vascular diameters and disease severity using multivariate logistic regression, with receiver operating characteristic (ROC) curve analysis to determine diagnostic cut-off values. Results Patients with complicated diverticulitis exhibited significantly larger sigmoidal artery and vein diameters compared to those with uncomplicated disease (p < 0.001). The optimal cut-off values for predicting complications were 3.15 mm for the sigmoidal artery and 3.85 mm for the sigmoidal vein, with sensitivities of 78% and 82%, and specificities of 76% and 81%, respectively. Multivariate analysis confirmed that increased vascular diameters and elevated neutrophil-to-lymphocyte ratio (NLR) were independent predictors of complicated diverticulitis (p < 0.05). Conclusions Vascular measurements of the sigmoidal arteries and veins, along with inflammatory markers, can enhance the prediction of complications in acute sigmoid diverticulitis. These measurements may serve as valuable tools for guiding treatment decisions, potentially improving patient outcomes through early identification of high-risk cases. Sigmoid Diverticulitis Vascular Remodeling Computed Tomography Prognosis Figures Figure 1 İntroduction Acute diverticulitis is a prevalent inflammatory condition of the colon, particularly in the sigmoid segment, resulting from the microperforation of a diverticulum. Diverticulitis most commonly affects individuals over the age of 40, with its incidence increasing significantly with age, especially in industrialized nations where up to 70% of the population may be affected by diverticulosis, the precursor condition. Diverticulosis, the precursor condition characterized by the formation of sac-like outpouchings in the colonic wall, affects up to 70% of the population in industrialized countries, with an increased prevalence in older adults ( 1 ). Although most cases remain asymptomatic, approximately 10–25% of individuals with diverticulosis will develop diverticulitis during their lifetime ( 2 ). The annual incidence of diverticulitis is estimated to be around 4–10 cases per 1,000 individuals, with a slightly higher prevalence in males compared to females. The clinical course of diverticulitis can range from uncomplicated cases to complicated forms involving abscesses, fistulas, perforation, or bowel obstruction, each of which poses significant diagnostic and therapeutic challenges ( 3 ). The early diagnosis of acute diverticulitis is essential to prevent complications such as abscess formation, bowel perforation, or sepsis, which can significantly increase morbidity and mortality. The severity of diverticulitis and the risk of complications remain key concerns in clinical practice. Currently, computed tomography (CT) is considered the gold standard for diagnosing acute diverticulitis, providing detailed anatomical insights that guide therapeutic decision-making. However, its prognostic value in determining the clinical course and risk of complications is limited, highlighting the need for additional predictive markers. While CT is the gold standard for diagnosing diverticulitis and assessing disease severity, it provides limited prognostic information regarding the progression of the disease. Consequently, there is an unmet need for reliable, early biomarkers that can predict clinical outcomes and guide management strategies ( 4 ). Emerging evidence suggests that vascular changes, particularly in the sigmoidal arteries and veins, may play a critical role in the pathophysiology of diverticulitis. Similar to other inflammatory gastrointestinal conditions such as appendicitis, where vascular remodeling occurs in response to localized inflammation, diverticulitis may exhibit vascular changes that correlate with disease severity. Increased vascular diameters in response to inflammation could serve as predictive markers for disease severity, helping clinicians identify patients at higher risk for complications ( 5 ). This study aims to evaluate the diameters of the sigmoidal arteries and veins during acute episodes of sigmoid diverticulitis and investigate their correlation with the Hinchey classification, a system used to categorize the severity of diverticulitis. We hypothesize that increased vascular diameters, as measured by contrast-enhanced CT, are associated with more severe forms of diverticulitis, including those with complications such as abscess formation and perforation. By analyzing these vascular changes, we propose that they may serve as early markers for predicting clinical severity, offering a novel approach to improving diagnosis and guiding treatment decisions in patients with acute sigmoid diverticulitis ( 6 ). The findings of this study could contribute to the growing body of literature on diverticulitis and provide a foundation for more tailored therapeutic interventions. Material and Methods Study Design and Setting The present retrospective cross-sectional study was carried out at the Faculty of Medicine, Hitit University, over a five-year period spanning from May 2018 to May 2023. The study adhered to the STROBE guidelines for observational studies and was approved by the Institutional Review Board of the Hitit Univercıty Faculty of Medicine Clinical Research Ethics Committee (protocol number: 2023 − 105). Data were retrospectively collected from patients diagnosed with acute sigmoid diverticulitis who presented to the General Surgery Department. Ethical approval for the study was granted by the institutional review board, and patient confidentiality was rigorously safeguarded through the anonymization of all patient records in accordance with ethical standards. Study Population Patients included in the study were diagnosed with acute sigmoid diverticulitis based on comprehensive clinical evaluation, corroborated by laboratory findings and confirmed through CT imaging. The study population consisted of adults aged 18 and older who were admitted to the emergency department with suspected diverticulitis. The diagnosis of diverticulitis was confirmed through multi-slice CT imaging performed in the emergency department. Patients were excluded if they had a history of prior colorectal surgery, known inflammatory bowel disease, or other colorectal pathologies that could confound vascular measurements. Patients were divided into two groups according to the presence or absence of complications, as classified by the modified Hinchey classification. Group 1, consisting of patients with uncomplicated diverticulitis, included those who presented with localized inflammation confined to the colonic wall, with no evidence of abscess, fistula, perforation, or bowel obstruction. These cases corresponded to Hinchey Stage 0 or Ia, where the inflammation remained uncomplicated. Group 2, which included patients with complicated diverticulitis, was defined based on the presence of abscesses (Hinchey Stage Ib or II), fistulas (Hinchey Stage III), free perforation with generalized peritonitis (Hinchey Stage IV), or bowel obstruction identified through imaging or clinical diagnosis. Inclusion and Exclusion Criteria Patients were included in the study if they had a confirmed CT diagnosis of acute sigmoid diverticulitis. Exclusion criteria included patients with incomplete imaging studies, previous colorectal surgeries, or co-existing colorectal diseases, such as inflammatory bowel disease, that could interfere with the vascular measurements. Additionally, patients with known hematological, oncological, vascular, or endothelial diseases were excluded to minimize potential confounding factors. Data Collection Demographic data, including age, sex, and clinical history, were extracted from patient medical records. In addition to demographic information, clinical and imaging parameters such as sigmoidal artery and vein diameters, presence of perisigmoidal fluid, mesenteric lymph nodes, C-reactive protein (CRP) levels, neutrophil-to-lymphocyte ratio (NLR), and Hinchey classification were collected for further analysis. CT Examination CT studies were performed using a 64-slice multi-detector CT scanner (Aquilion, Toshiba, Japan). The imaging protocol included the administration of intravenous contrast, with scans performed from the diaphragm to the pelvic floor. Portal venous phase images were obtained approximately 60 seconds after contrast injection, with an injection rate of 2–3 mL/s. Vascular measurements were taken from both the arterial and venous phases of contrast-enhanced CT scans, and these measurements were performed by a single radiologist who was blinded to the clinical outcomes of the patients. The diameters of the sigmoidal artery and vein were measured in the sigmoid mesocolon at consistent anatomical landmarks across all patients. For standardization, the measurements were taken in the axial plane at a distance of 2 cm from the origin of the inferior mesenteric artery and vein, respectively. The optimal axial planes for vascular measurements were standardized to ensure reproducibility of the results. Statistical Analysis All statistical analyses were conducted using SPSS version 21.0 (IBM Corp., Chicago, IL, USA). Continuous variables were expressed as mean ± standard deviation (SD) or median (min-max) depending on the distribution of the data. Categorical variables were reported as frequencies and percentages. The normality of continuous variables was assessed using the Kolmogorov-Smirnov test. To compare the differences between patients with uncomplicated diverticulitis (Group 1) and complicated diverticulitis (Group 2), an independent samples t-test was used for normally distributed continuous variables, while the Mann-Whitney U test was applied to non-normally distributed variables. Categorical variables, such as gender and presence of mesenteric lymph nodes, were analyzed using the chi-square test or Fisher’s exact test, depending on sample size. To evaluate the predictive value of sigmoidal artery and vein diameters in identifying complicated diverticulitis, a Receiver Operating Characteristic (ROC) curve analysis was performed. The area under the curve (AUC) was calculated with 95% confidence intervals to assess the diagnostic accuracy of vascular measurements. The optimal cut-off values for the diameters were determined using the Youden Index. Furthermore, a binary logistic regression analysis was conducted to identify independent predictors of complicated diverticulitis. Variables with p-values < 0.05 in the univariate analysis were included in the multivariate model to control for confounding factors. Odds ratios (OR) and 95% confidence intervals (CI) were reported, and statistical significance was set at a p-value of < 0.05. Results Patient Demographics and Clinical Characteristics A total of 160 patients with confirmed acute sigmoid diverticulitis were included in the study. Of these, 95 patients (59.4%) were classified as having uncomplicated diverticulitis (Group 1), while 65 patients (40.6%) were classified as having complicated diverticulitis (Group 2) based on the modified Hinchey classification. The mean age of patients in Group 1 was 54.2 ± 12.5 years, which was significantly younger than the mean age of patients in Group 2, who had a mean age of 63.8 ± 14.2 years (p < 0.001). No statistically significant difference was found in the gender distribution between the two groups (p = 0.35), with males comprising 60.8% of the total cohort. Inflammatory markers were significantly higher in patients with complicated diverticulitis. The mean CRP level in Group 2 was 89.2 ± 25.3 mg/L, while in Group 1 it was 42.5 ± 18.6 mg/L, showing a statistically significant difference (p < 0.001). Similarly, the NLR was significantly elevated in Group 2, with a median value of 9.1 (IQR 6.3–12.5) compared to 4.6 (IQR 2.8–7.2) in Group 1 (p < 0.001). These findings suggest a stronger inflammatory response in patients with complicated diverticulitis, which correlates with the clinical severity of the disease. The demographic and clinical characteristics of the study population are summarized in Table 1 . Table 1 Demographic and Clinical Characteristics of Patients | Characteristic Group 1 (Uncomplicated) Group 2 (Complicated) p-value Age, years (mean ± SD) 54.2 ± 12.5 63.8 ± 14.2 < 0.001* Gender, Male, n (%) 55 (57.9%) 42 (64.6%) 350 CRP level, mg/L (mean ± SD) 42.5 ± 18.6 89.2 ± 25.3 < 0.001* NLR (median, IQR) 4.6 (2.8–7.2) 9.1 (6.3–12.5) < 0.001* Presence of mesenteric lymph nodes, n (%) 31 (32.6%) 49 (75.4%) < 0.001* *Statistically significant difference at p < 0.05. Sigmoidal Artery and Vein Diameters The diameters of the sigmoidal artery and vein were measured and compared between the two groups. Patients in Group 2, with complicated diverticulitis, exhibited significantly larger sigmoidal artery and vein diameters compared to patients in Group 1. The mean sigmoidal artery diameter in Group 1 was 2.79 ± 0.57 mm, while in Group 2, it was 3.55 ± 0.79 mm (p < 0.001). Similarly, the mean sigmoidal vein diameter was 3.24 ± 0.69 mm in Group 1, compared to 4.27 ± 0.89 mm in Group 2 (p < 0.001). These results indicate a statistically significant increase in both arterial and venous diameters in patients with complicated diverticulitis, suggesting that vascular changes are associated with disease severity. The detailed vascular measurements are presented in Table 2 . Table 2 Vascular Measurements in Acute Sigmoid Diverticulitis | Vascular Parameter (mm) Group 1 (Uncomplicated) Group 2 (Complicated) p-value Sigmoidal Artery Diameter (mean ± SD) 2.79 ± 0.57 3.55 ± 0.79 < 0.001* Sigmoidal Vein Diameter (mean ± SD) 3.24 ± 0.69 4.27 ± 0.89 < 0.001* *Statistically significant difference at p < 0.05. ROC Curve Analysis To further assess the diagnostic performance of sigmoidal artery and vein diameters in predicting complicated diverticulitis, a ROC curve analysis was performed. The area under the curve (AUC) for sigmoidal artery diameter was 0.83 (95% CI: 0.76–0.89), indicating good diagnostic accuracy, while the AUC for sigmoidal vein diameter was 0.87 (95% CI: 0.80–0.92), reflecting excellent diagnostic performance. The optimal cut-off values for predicting complicated diverticulitis were determined to be 3.15 mm for the sigmoidal artery and 3.85 mm for the sigmoidal vein, with sensitivities of 78% and 82%, and specificities of 76% and 81%, respectively. These findings suggest that increased vascular diameters can serve as reliable markers for identifying patients at higher risk of complications in acute diverticulitis. Multivariate Logistic Regression Analysis A multivariate logistic regression analysis was performed to identify independent predictors of complicated diverticulitis. After adjusting for potential confounding variables, sigmoidal artery diameter, sigmoidal vein diameter, and NLR remained significant independent predictors of complicated diverticulitis. The OR for sigmoidal artery diameter was 2.42 (95% CI: 1.65–3.54), indicating that for each 1 mm increase in arterial diameter, the odds of developing complicated diverticulitis increased by 2.42-fold. Similarly, the OR for sigmoidal vein diameter was 2.89 (95% CI: 1.91–4.37), indicating a significant association between larger venous diameters and the likelihood of complications. These results confirm that both arterial and venous diameters, as well as elevated NLR, are independent predictors of complicated diverticulitis. The results of the multivariate analysis are shown in Table 3 . Table 3 Multivariate Logistic Regression for Predictors of Complicated Diverticulitis Variable Odds Ratio (95% CI) p-value Sigmoidal Artery Diameter 2.42 (1.65–3.54) < 0.001* Sigmoidal Vein Diameter 2.89 (1.91–4.37) < 0.001* Neutrophil-to-Lymphocyte Ratio 1.38 (1.10–1.75) 0.005* *Statistically significant at p < 0.05. Discussion In this study, we evaluated the role of sigmoidal artery and vein diameters as predictive markers for complicated diverticulitis. Our findings demonstrate that these vascular measurements, easily obtained through routine CT imaging, provide valuable information for assessing disease severity in acute sigmoid diverticulitis. Specifically, the enlargement of the sigmoidal artery and vein was closely associated with the development of complications such as abscess formation, fistula, and perforation. These findings suggest that incorporating vascular measurements into clinical practice may improve early detection of high-risk patients, guiding more aggressive treatment strategies and potentially reducing the risk of complications. The correlation between vascular changes and disease severity is supported by well-documented physiological mechanisms. Similar to what has been observed in other inflammatory gastrointestinal conditions, such as appendicitis, vascular remodeling occurs in response to localized inflammation. In sigmoid diverticulitis, inflammation triggers dilation of the sigmoidal arteries and veins, increasing blood flow to the affected area. This vascular response is essential for managing the local inflammatory process, but as our study shows, excessive dilation may signal the progression toward more severe, complicated forms of the disease. Our findings align with previous research indicating that vascular changes are a common feature of inflammatory gastrointestinal diseases, where vessel dilation occurs to accommodate increased blood flow and nutrient delivery to the inflamed tissues. This process is crucial for the containment of inflammation, but when excessive, it can contribute to complications such as abscesses and perforations ( 5 , 6 ). The strong diagnostic performance of vascular measurements, as indicated by the area under the curve (AUC) values of 0.83 for the sigmoidal artery and 0.87 for the sigmoidal vein, highlights their potential as reliable biomarkers for diverticulitis severity. In comparison to traditional markers of inflammation, such as CRP and the neutrophil-to-lymphocyte ratio (NLR), sigmoidal artery and vein diameters offer a more direct insight into the localized vascular changes associated with sigmoid diverticulitis. While CRP and NLR provide general information about systemic inflammation, vascular measurements reflect the anatomical and pathophysiological changes occurring within the sigmoid colon. This complementary relationship between systemic inflammatory markers and localized vascular measurements suggests that using both together may offer a more comprehensive assessment of disease severity These findings align with other studies, which have also shown the value of incorporating anatomical data into clinical decision-making for gastrointestinal diseases ( 7 , 8 ). One of the key strengths of this study is the use of multivariate logistic regression analysis, which confirmed that sigmoidal artery and vein diameters are independent predictors of complicated diverticulitis, even after adjusting for other variables. A 1 mm increase in the artery or vein diameter was associated with more than a twofold increase in the odds of having complicated diverticulitis, emphasizing the importance of monitoring vascular changes in patients with this condition. These results are consistent with similar studies in appendicitis, where increased vascular diameters were also found to be predictive of disease severity and the likelihood of complications. This suggests that vascular changes may be a common marker of disease progression across various gastrointestinal inflammatory conditions ( 1 , 2 ). From a clinical perspective, the integration of vascular measurements into routine practice could significantly improve patient outcomes by guiding tailored treatment decisions. Patients with significantly enlarged arteries and veins may benefit from early surgical consultation, closer inpatient monitoring, or more intensive antibiotic therapy, even if their clinical presentation initially suggests a milder disease course. Conversely, patients with smaller vessel diameters and fewer risk factors may be safely managed on an outpatient basis, avoiding unnecessary hospital admissions or invasive interventions. This stratified approach aligns with current trends in personalized medicine, where treatment is tailored to the specific characteristics and risk profiles of individual patients ( 3 , 9 ). The integration of vascular measurements into routine practice could also improve patient outcomes by guiding treatment decisions. Patients with significant vascular enlargement may benefit from early surgical consultation, close inpatient monitoring, or more intensive antibiotic therapy, even if their clinical presentation suggests a milder disease course. Conversely, patients with smaller vessel diameters and fewer risk factors may be safely managed on an outpatient basis, avoiding unnecessary hospital admissions and invasive procedures. This stratified approach to treatment aligns with current trends in personalized medicine, where clinical interventions are tailored to the specific characteristics of each patient ( 10 , 11 ). Our findings are consistent with previous studies that emphasize the role of vascular changes in gastrointestinal diseases, particularly in conditions such as inflammatory bowel disease (IBD), where increased blood flow and vessel dilation are common markers of disease activity. Similar mechanisms are likely at play in diverticulitis, where localized inflammation triggers vascular changes in the sigmoid colon. By focusing on the quantifiable measurements of sigmoidal artery and vein diameters, our study adds precision to the understanding of how these vascular changes correlate with disease severity. Additionally, the establishment of clear cut-off values provides practical utility for clinicians, allowing them to use these measurements confidently in guiding treatment decisions ( 12 , 13 ). The pathophysiological basis for our findings is supported by the broader literature on inflammation and vascular remodeling. Inflammation in diverticulitis leads to the release of cytokines and other inflammatory mediators, which induce vasodilation, thereby increasing oxygen and nutrient supply to the affected tissues. However, prolonged or excessive inflammation can lead to pathological vascular remodeling, which increases the risk of complications, such as abscess formation, fistulas, and perforations. Our findings suggest that these vascular changes are not just a consequence of inflammation but may play an integral role in the disease process, potentially serving as early indicators of worsening disease severity ( 9 , 14 ). Despite the promising implications of this study, there are several limitations that must be considered. First, as a retrospective analysis, there is an inherent risk of selection bias and confounding factors that could influence the results. Although we used multivariate analysis to adjust for confounders, prospective studies are needed to validate these findings in a broader patient population. Second, the study was conducted at a single institution, which may limit the generalizability of the results to other clinical settings. Future research should focus on multicenter studies to confirm the utility of vascular measurements in diverse populations and healthcare environments. Another limitation is the lack of long-term follow-up data. While this study focused on short-term outcomes, such as the development of complications during the acute phase of diverticulitis, it remains unclear whether vascular measurements can predict long-term outcomes, including recurrence or chronic complications. Future studies should explore whether sigmoidal artery and vein diameters are associated with recurrence rates and other long-term outcomes in patients with acute diverticulitis. Finally, we did not evaluate the potential effects of different treatment modalities on vascular changes. Whether treatments aimed at reducing inflammation, such as antibiotics or surgery, have a direct impact on vessel diameters remains to be determined. Conclusion This study highlights the clinical relevance of sigmoidal artery and vein diameters as predictive markers for complicated diverticulitis. These vascular measurements provide a reliable, non-invasive tool that can be easily incorporated into routine CT imaging, offering clinicians objective data to guide treatment decisions. By identifying patients at higher risk for complications early in the disease course, healthcare providers can intervene more aggressively when necessary, potentially preventing disease progression and improving patient outcomes. Future research should aim to validate these findings in larger, prospective studies and explore the potential for incorporating vascular measurements into existing classification systems for diverticulitis. Abbreviations CT: computed tomography ROC: receiver operating characteristic AUC: area under the curve OR: Odds ratios CI: confidence intervals CRP: C-reactive protein NLR neutrophil-to-lymphocyte ratio IBD: inflammatory bowel disease Declarations Ethics approval and consent to participate The study adhered to the STROBE guidelines for observational studies and was approved by the Institutional Review Board of the Hitit Univercıty Faculty of Medicine Clinical Research Ethics Committee (protocol number: 2023-105). Data were retrospectively collected from patients diagnosed with acute sigmoid diverticulitis who presented to the General Surgery Department. Ethical approval for the study was granted by the institutional review board, and patient confidentiality was rigorously safeguarded through the anonymization of all patient records in accordance with ethical standards. Consent for publication: For this type of study formal consent is not required. Data availability: The dataset analyzed for this study is available from the corresponding author on reasonable request. Conflict of Interest: Authors declares that they have no conflict of interest. Funding: The study had no funding source Author information Authors and Affiliations 1: Hitit University, Faculty of Medicine, Department of Surgery, Çorum, Turkey 2: Hitit University, Faculty of Medicine, Department of Radiology, Çorum, Turkey Contributions All authors made substantive intellectual contributions in this study to qualify as authors. RT and OA: Conceptualization, literature review, protocol development and abstract review, data extraction, revision, and submission. İS,MK and VBT: Title, manuscript writing, Data analysis and Data Collection. NF and İS: Manuscript revision, Submission and Supervision. All authors have read and approved the final version of themanuscript, and agree with the order of presentation of the authors Acknowledgements: Thank you. 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Cold Spring Harb Perspect Biol. 2015;7. Munie ST, Nalamati SP. Epidemiology and pathophysiology of diverticular disease. Clin Colon Rectal Surg. 2018;31:209–13. Migaly J, Bafford AC, Francone TD, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of diverticulitis. Dis Colon Rectum. 2020;63(6):728–47. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5493445","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":381274065,"identity":"27286ecb-8dd2-4577-84fc-778d08063c99","order_by":0,"name":"İsmail SEZİKLİ","email":"","orcid":"","institution":"Hitit University","correspondingAuthor":false,"prefix":"","firstName":"İsmail","middleName":"","lastName":"SEZİKLİ","suffix":""},{"id":381274066,"identity":"6416fb35-0bf1-43f9-9752-e6f2cf1d0127","order_by":1,"name":"Nurdan FİDAN","email":"","orcid":"","institution":"Hitit University","correspondingAuthor":false,"prefix":"","firstName":"Nurdan","middleName":"","lastName":"FİDAN","suffix":""},{"id":381274067,"identity":"cfc5513b-25ca-4788-a720-bf6fef6c7490","order_by":2,"name":"Ramazan TOPCU","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYPCCf3L8ICqhgAi1PBDqgLFkA0iLAQlaEjccANHEaLFn7z34mXfPHWPj86sTPzwwYJDnFztAwBaec8nSPM+eyZndeLtZAugww5mzEwhokcgxY+Y5wGxsduPsBpCWBIPbRGpJ3Dzj7OYfpGg5nLiBv3cbkbacOZcsOedAmrHEDd5tFgkGEoT9wt7ee/DDmwM2cvz9Zzff/FFhI88vTUALPGYYJMAqJQgpR9bCf4AY1aNgFIyCUTASAQAZkULpcuaMfAAAAABJRU5ErkJggg==","orcid":"","institution":"Hitit University","correspondingAuthor":true,"prefix":"","firstName":"Ramazan","middleName":"","lastName":"TOPCU","suffix":""},{"id":381274068,"identity":"e4490493-33e1-4192-b5c7-31f8bd96ef25","order_by":3,"name":"Veysel Barış TURHAN","email":"","orcid":"","institution":"Hitit University","correspondingAuthor":false,"prefix":"","firstName":"Veysel","middleName":"Barış","lastName":"TURHAN","suffix":""},{"id":381274069,"identity":"da5fae09-052a-42c6-8f7d-cc599379dff9","order_by":4,"name":"Orhan ASLAN","email":"","orcid":"","institution":"Hitit University","correspondingAuthor":false,"prefix":"","firstName":"Orhan","middleName":"","lastName":"ASLAN","suffix":""},{"id":381274070,"identity":"f35678d1-b88e-4c11-9607-ade17562edd2","order_by":5,"name":"Murat KENDİRCİ","email":"","orcid":"","institution":"Hitit University","correspondingAuthor":false,"prefix":"","firstName":"Murat","middleName":"","lastName":"KENDİRCİ","suffix":""}],"badges":[],"createdAt":"2024-11-20 21:38:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5493445/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5493445/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":70118094,"identity":"0f4401d3-7fa6-4481-bbab-81313f2ede73","added_by":"auto","created_at":"2024-11-28 13:41:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":66901,"visible":true,"origin":"","legend":"\u003cp\u003eROC Curves for Sigmoidal Artery and Vein Diameters\u003c/p\u003e\n\u003cp\u003e(Insert ROC figure here showing the performance of artery and vein measurements).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5493445/v1/8895b3a7a6bdc20b60a4b3bf.png"},{"id":70118095,"identity":"3c106a3c-1669-4804-b9a5-d8d975d8791d","added_by":"auto","created_at":"2024-11-28 13:41:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":598068,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5493445/v1/95724960-7f92-4eea-9edc-db5677131cda.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eAssessment of Sigmoidal Artery and Vein Diameters as Predictive Markers for Complications in Acute Sigmoid Diverticulitis: A Retrospective Observational Analysis\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"İntroduction","content":"\u003cp\u003eAcute diverticulitis is a prevalent inflammatory condition of the colon, particularly in the sigmoid segment, resulting from the microperforation of a diverticulum. Diverticulitis most commonly affects individuals over the age of 40, with its incidence increasing significantly with age, especially in industrialized nations where up to 70% of the population may be affected by diverticulosis, the precursor condition. Diverticulosis, the precursor condition characterized by the formation of sac-like outpouchings in the colonic wall, affects up to 70% of the population in industrialized countries, with an increased prevalence in older adults (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Although most cases remain asymptomatic, approximately 10\u0026ndash;25% of individuals with diverticulosis will develop diverticulitis during their lifetime (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The annual incidence of diverticulitis is estimated to be around 4\u0026ndash;10 cases per 1,000 individuals, with a slightly higher prevalence in males compared to females. The clinical course of diverticulitis can range from uncomplicated cases to complicated forms involving abscesses, fistulas, perforation, or bowel obstruction, each of which poses significant diagnostic and therapeutic challenges (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe early diagnosis of acute diverticulitis is essential to prevent complications such as abscess formation, bowel perforation, or sepsis, which can significantly increase morbidity and mortality. The severity of diverticulitis and the risk of complications remain key concerns in clinical practice. Currently, computed tomography (CT) is considered the gold standard for diagnosing acute diverticulitis, providing detailed anatomical insights that guide therapeutic decision-making. However, its prognostic value in determining the clinical course and risk of complications is limited, highlighting the need for additional predictive markers. While CT is the gold standard for diagnosing diverticulitis and assessing disease severity, it provides limited prognostic information regarding the progression of the disease. Consequently, there is an unmet need for reliable, early biomarkers that can predict clinical outcomes and guide management strategies (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Emerging evidence suggests that vascular changes, particularly in the sigmoidal arteries and veins, may play a critical role in the pathophysiology of diverticulitis. Similar to other inflammatory gastrointestinal conditions such as appendicitis, where vascular remodeling occurs in response to localized inflammation, diverticulitis may exhibit vascular changes that correlate with disease severity. Increased vascular diameters in response to inflammation could serve as predictive markers for disease severity, helping clinicians identify patients at higher risk for complications (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study aims to evaluate the diameters of the sigmoidal arteries and veins during acute episodes of sigmoid diverticulitis and investigate their correlation with the Hinchey classification, a system used to categorize the severity of diverticulitis. We hypothesize that increased vascular diameters, as measured by contrast-enhanced CT, are associated with more severe forms of diverticulitis, including those with complications such as abscess formation and perforation. By analyzing these vascular changes, we propose that they may serve as early markers for predicting clinical severity, offering a novel approach to improving diagnosis and guiding treatment decisions in patients with acute sigmoid diverticulitis (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The findings of this study could contribute to the growing body of literature on diverticulitis and provide a foundation for more tailored therapeutic interventions.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Setting\u003c/h2\u003e \u003cp\u003eThe present retrospective cross-sectional study was carried out at the Faculty of Medicine, Hitit University, over a five-year period spanning from May 2018 to May 2023. The study adhered to the STROBE guidelines for observational studies and was approved by the Institutional Review Board of the Hitit Univercıty Faculty of Medicine Clinical Research Ethics Committee (protocol number: 2023\u0026thinsp;\u0026minus;\u0026thinsp;105). Data were retrospectively collected from patients diagnosed with acute sigmoid diverticulitis who presented to the General Surgery Department. Ethical approval for the study was granted by the institutional review board, and patient confidentiality was rigorously safeguarded through the anonymization of all patient records in accordance with ethical standards.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003ePatients included in the study were diagnosed with acute sigmoid diverticulitis based on comprehensive clinical evaluation, corroborated by laboratory findings and confirmed through CT imaging. The study population consisted of adults aged 18 and older who were admitted to the emergency department with suspected diverticulitis. The diagnosis of diverticulitis was confirmed through multi-slice CT imaging performed in the emergency department. Patients were excluded if they had a history of prior colorectal surgery, known inflammatory bowel disease, or other colorectal pathologies that could confound vascular measurements.\u003c/p\u003e \u003cp\u003ePatients were divided into two groups according to the presence or absence of complications, as classified by the modified Hinchey classification. Group 1, consisting of patients with uncomplicated diverticulitis, included those who presented with localized inflammation confined to the colonic wall, with no evidence of abscess, fistula, perforation, or bowel obstruction. These cases corresponded to Hinchey Stage 0 or Ia, where the inflammation remained uncomplicated. Group 2, which included patients with complicated diverticulitis, was defined based on the presence of abscesses (Hinchey Stage Ib or II), fistulas (Hinchey Stage III), free perforation with generalized peritonitis (Hinchey Stage IV), or bowel obstruction identified through imaging or clinical diagnosis.\u003c/p\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003ePatients were included in the study if they had a confirmed CT diagnosis of acute sigmoid diverticulitis. Exclusion criteria included patients with incomplete imaging studies, previous colorectal surgeries, or co-existing colorectal diseases, such as inflammatory bowel disease, that could interfere with the vascular measurements. Additionally, patients with known hematological, oncological, vascular, or endothelial diseases were excluded to minimize potential confounding factors.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eDemographic data, including age, sex, and clinical history, were extracted from patient medical records. In addition to demographic information, clinical and imaging parameters such as sigmoidal artery and vein diameters, presence of perisigmoidal fluid, mesenteric lymph nodes, C-reactive protein (CRP) levels, neutrophil-to-lymphocyte ratio (NLR), and Hinchey classification were collected for further analysis.\u003c/p\u003e\n\u003ch3\u003eCT Examination\u003c/h3\u003e\n\u003cp\u003eCT studies were performed using a 64-slice multi-detector CT scanner (Aquilion, Toshiba, Japan). The imaging protocol included the administration of intravenous contrast, with scans performed from the diaphragm to the pelvic floor. Portal venous phase images were obtained approximately 60 seconds after contrast injection, with an injection rate of 2\u0026ndash;3 mL/s. Vascular measurements were taken from both the arterial and venous phases of contrast-enhanced CT scans, and these measurements were performed by a single radiologist who was blinded to the clinical outcomes of the patients. The diameters of the sigmoidal artery and vein were measured in the sigmoid mesocolon at consistent anatomical landmarks across all patients. For standardization, the measurements were taken in the axial plane at a distance of 2 cm from the origin of the inferior mesenteric artery and vein, respectively. The optimal axial planes for vascular measurements were standardized to ensure reproducibility of the results.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were conducted using SPSS version 21.0 (IBM Corp., Chicago, IL, USA). Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) or median (min-max) depending on the distribution of the data. Categorical variables were reported as frequencies and percentages. The normality of continuous variables was assessed using the Kolmogorov-Smirnov test.\u003c/p\u003e \u003cp\u003eTo compare the differences between patients with uncomplicated diverticulitis (Group 1) and complicated diverticulitis (Group 2), an independent samples t-test was used for normally distributed continuous variables, while the Mann-Whitney U test was applied to non-normally distributed variables. Categorical variables, such as gender and presence of mesenteric lymph nodes, were analyzed using the chi-square test or Fisher\u0026rsquo;s exact test, depending on sample size.\u003c/p\u003e \u003cp\u003eTo evaluate the predictive value of sigmoidal artery and vein diameters in identifying complicated diverticulitis, a Receiver Operating Characteristic (ROC) curve analysis was performed. The area under the curve (AUC) was calculated with 95% confidence intervals to assess the diagnostic accuracy of vascular measurements. The optimal cut-off values for the diameters were determined using the Youden Index. Furthermore, a binary logistic regression analysis was conducted to identify independent predictors of complicated diverticulitis. Variables with p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in the univariate analysis were included in the multivariate model to control for confounding factors. Odds ratios (OR) and 95% confidence intervals (CI) were reported, and statistical significance was set at a p-value of \u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003ePatient Demographics and Clinical Characteristics\u003c/h2\u003e \u003cp\u003eA total of 160 patients with confirmed acute sigmoid diverticulitis were included in the study. Of these, 95 patients (59.4%) were classified as having uncomplicated diverticulitis (Group 1), while 65 patients (40.6%) were classified as having complicated diverticulitis (Group 2) based on the modified Hinchey classification. The mean age of patients in Group 1 was 54.2\u0026thinsp;\u0026plusmn;\u0026thinsp;12.5 years, which was significantly younger than the mean age of patients in Group 2, who had a mean age of 63.8\u0026thinsp;\u0026plusmn;\u0026thinsp;14.2 years (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No statistically significant difference was found in the gender distribution between the two groups (p\u0026thinsp;=\u0026thinsp;0.35), with males comprising 60.8% of the total cohort.\u003c/p\u003e \u003cp\u003eInflammatory markers were significantly higher in patients with complicated diverticulitis. The mean CRP level in Group 2 was 89.2\u0026thinsp;\u0026plusmn;\u0026thinsp;25.3 mg/L, while in Group 1 it was 42.5\u0026thinsp;\u0026plusmn;\u0026thinsp;18.6 mg/L, showing a statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, the NLR was significantly elevated in Group 2, with a median value of 9.1 (IQR 6.3\u0026ndash;12.5) compared to 4.6 (IQR 2.8\u0026ndash;7.2) in Group 1 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These findings suggest a stronger inflammatory response in patients with complicated diverticulitis, which correlates with the clinical severity of the disease. The demographic and clinical characteristics of the study population are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and Clinical Characteristics of Patients |\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup 1 (Uncomplicated)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup 2 (Complicated)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge, years (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54.2\u0026thinsp;\u0026plusmn;\u0026thinsp;12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.8\u0026thinsp;\u0026plusmn;\u0026thinsp;14.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender, Male, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (57.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (64.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e350\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCRP level, mg/L (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.5\u0026thinsp;\u0026plusmn;\u0026thinsp;18.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89.2\u0026thinsp;\u0026plusmn;\u0026thinsp;25.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNLR (median, IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.6 (2.8\u0026ndash;7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.1 (6.3\u0026ndash;12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePresence of mesenteric lymph nodes, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (32.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (75.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*Statistically significant difference at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSigmoidal Artery and Vein Diameters\u003c/h2\u003e \u003cp\u003eThe diameters of the sigmoidal artery and vein were measured and compared between the two groups. Patients in Group 2, with complicated diverticulitis, exhibited significantly larger sigmoidal artery and vein diameters compared to patients in Group 1. The mean sigmoidal artery diameter in Group 1 was 2.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57 mm, while in Group 2, it was 3.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79 mm (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, the mean sigmoidal vein diameter was 3.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69 mm in Group 1, compared to 4.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89 mm in Group 2 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These results indicate a statistically significant increase in both arterial and venous diameters in patients with complicated diverticulitis, suggesting that vascular changes are associated with disease severity. The detailed vascular measurements are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVascular Measurements in Acute Sigmoid Diverticulitis |\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVascular Parameter (mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup 1 (Uncomplicated)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup 2 (Complicated)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSigmoidal Artery Diameter (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSigmoidal Vein Diameter (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*Statistically significant difference at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eROC Curve Analysis\u003c/h2\u003e \u003cp\u003eTo further assess the diagnostic performance of sigmoidal artery and vein diameters in predicting complicated diverticulitis, a ROC curve analysis was performed. The area under the curve (AUC) for sigmoidal artery diameter was 0.83 (95% CI: 0.76\u0026ndash;0.89), indicating good diagnostic accuracy, while the AUC for sigmoidal vein diameter was 0.87 (95% CI: 0.80\u0026ndash;0.92), reflecting excellent diagnostic performance. The optimal cut-off values for predicting complicated diverticulitis were determined to be 3.15 mm for the sigmoidal artery and 3.85 mm for the sigmoidal vein, with sensitivities of 78% and 82%, and specificities of 76% and 81%, respectively. These findings suggest that increased vascular diameters can serve as reliable markers for identifying patients at higher risk of complications in acute diverticulitis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eMultivariate Logistic Regression Analysis\u003c/h2\u003e \u003cp\u003eA multivariate logistic regression analysis was performed to identify independent predictors of complicated diverticulitis. After adjusting for potential confounding variables, sigmoidal artery diameter, sigmoidal vein diameter, and NLR remained significant independent predictors of complicated diverticulitis. The OR for sigmoidal artery diameter was 2.42 (95% CI: 1.65\u0026ndash;3.54), indicating that for each 1 mm increase in arterial diameter, the odds of developing complicated diverticulitis increased by 2.42-fold. Similarly, the OR for sigmoidal vein diameter was 2.89 (95% CI: 1.91\u0026ndash;4.37), indicating a significant association between larger venous diameters and the likelihood of complications. These results confirm that both arterial and venous diameters, as well as elevated NLR, are independent predictors of complicated diverticulitis. The results of the multivariate analysis are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate Logistic Regression for Predictors of Complicated Diverticulitis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOdds Ratio (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSigmoidal Artery Diameter\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.42 (1.65\u0026ndash;3.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSigmoidal Vein Diameter\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.89 (1.91\u0026ndash;4.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeutrophil-to-Lymphocyte Ratio\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.38 (1.10\u0026ndash;1.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.005*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e*Statistically significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we evaluated the role of sigmoidal artery and vein diameters as predictive markers for complicated diverticulitis. Our findings demonstrate that these vascular measurements, easily obtained through routine CT imaging, provide valuable information for assessing disease severity in acute sigmoid diverticulitis. Specifically, the enlargement of the sigmoidal artery and vein was closely associated with the development of complications such as abscess formation, fistula, and perforation. These findings suggest that incorporating vascular measurements into clinical practice may improve early detection of high-risk patients, guiding more aggressive treatment strategies and potentially reducing the risk of complications.\u003c/p\u003e \u003cp\u003eThe correlation between vascular changes and disease severity is supported by well-documented physiological mechanisms. Similar to what has been observed in other inflammatory gastrointestinal conditions, such as appendicitis, vascular remodeling occurs in response to localized inflammation. In sigmoid diverticulitis, inflammation triggers dilation of the sigmoidal arteries and veins, increasing blood flow to the affected area. This vascular response is essential for managing the local inflammatory process, but as our study shows, excessive dilation may signal the progression toward more severe, complicated forms of the disease. Our findings align with previous research indicating that vascular changes are a common feature of inflammatory gastrointestinal diseases, where vessel dilation occurs to accommodate increased blood flow and nutrient delivery to the inflamed tissues. This process is crucial for the containment of inflammation, but when excessive, it can contribute to complications such as abscesses and perforations (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe strong diagnostic performance of vascular measurements, as indicated by the area under the curve (AUC) values of 0.83 for the sigmoidal artery and 0.87 for the sigmoidal vein, highlights their potential as reliable biomarkers for diverticulitis severity. In comparison to traditional markers of inflammation, such as CRP and the neutrophil-to-lymphocyte ratio (NLR), sigmoidal artery and vein diameters offer a more direct insight into the localized vascular changes associated with sigmoid diverticulitis. While CRP and NLR provide general information about systemic inflammation, vascular measurements reflect the anatomical and pathophysiological changes occurring within the sigmoid colon. This complementary relationship between systemic inflammatory markers and localized vascular measurements suggests that using both together may offer a more comprehensive assessment of disease severity These findings align with other studies, which have also shown the value of incorporating anatomical data into clinical decision-making for gastrointestinal diseases (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOne of the key strengths of this study is the use of multivariate logistic regression analysis, which confirmed that sigmoidal artery and vein diameters are independent predictors of complicated diverticulitis, even after adjusting for other variables. A 1 mm increase in the artery or vein diameter was associated with more than a twofold increase in the odds of having complicated diverticulitis, emphasizing the importance of monitoring vascular changes in patients with this condition. These results are consistent with similar studies in appendicitis, where increased vascular diameters were also found to be predictive of disease severity and the likelihood of complications. This suggests that vascular changes may be a common marker of disease progression across various gastrointestinal inflammatory conditions (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFrom a clinical perspective, the integration of vascular measurements into routine practice could significantly improve patient outcomes by guiding tailored treatment decisions. Patients with significantly enlarged arteries and veins may benefit from early surgical consultation, closer inpatient monitoring, or more intensive antibiotic therapy, even if their clinical presentation initially suggests a milder disease course. Conversely, patients with smaller vessel diameters and fewer risk factors may be safely managed on an outpatient basis, avoiding unnecessary hospital admissions or invasive interventions. This stratified approach aligns with current trends in personalized medicine, where treatment is tailored to the specific characteristics and risk profiles of individual patients (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe integration of vascular measurements into routine practice could also improve patient outcomes by guiding treatment decisions. Patients with significant vascular enlargement may benefit from early surgical consultation, close inpatient monitoring, or more intensive antibiotic therapy, even if their clinical presentation suggests a milder disease course. Conversely, patients with smaller vessel diameters and fewer risk factors may be safely managed on an outpatient basis, avoiding unnecessary hospital admissions and invasive procedures. This stratified approach to treatment aligns with current trends in personalized medicine, where clinical interventions are tailored to the specific characteristics of each patient (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur findings are consistent with previous studies that emphasize the role of vascular changes in gastrointestinal diseases, particularly in conditions such as inflammatory bowel disease (IBD), where increased blood flow and vessel dilation are common markers of disease activity. Similar mechanisms are likely at play in diverticulitis, where localized inflammation triggers vascular changes in the sigmoid colon. By focusing on the quantifiable measurements of sigmoidal artery and vein diameters, our study adds precision to the understanding of how these vascular changes correlate with disease severity. Additionally, the establishment of clear cut-off values provides practical utility for clinicians, allowing them to use these measurements confidently in guiding treatment decisions (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe pathophysiological basis for our findings is supported by the broader literature on inflammation and vascular remodeling. Inflammation in diverticulitis leads to the release of cytokines and other inflammatory mediators, which induce vasodilation, thereby increasing oxygen and nutrient supply to the affected tissues. However, prolonged or excessive inflammation can lead to pathological vascular remodeling, which increases the risk of complications, such as abscess formation, fistulas, and perforations. Our findings suggest that these vascular changes are not just a consequence of inflammation but may play an integral role in the disease process, potentially serving as early indicators of worsening disease severity (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the promising implications of this study, there are several limitations that must be considered. First, as a retrospective analysis, there is an inherent risk of selection bias and confounding factors that could influence the results. Although we used multivariate analysis to adjust for confounders, prospective studies are needed to validate these findings in a broader patient population. Second, the study was conducted at a single institution, which may limit the generalizability of the results to other clinical settings. Future research should focus on multicenter studies to confirm the utility of vascular measurements in diverse populations and healthcare environments.\u003c/p\u003e \u003cp\u003eAnother limitation is the lack of long-term follow-up data. While this study focused on short-term outcomes, such as the development of complications during the acute phase of diverticulitis, it remains unclear whether vascular measurements can predict long-term outcomes, including recurrence or chronic complications. Future studies should explore whether sigmoidal artery and vein diameters are associated with recurrence rates and other long-term outcomes in patients with acute diverticulitis. Finally, we did not evaluate the potential effects of different treatment modalities on vascular changes. Whether treatments aimed at reducing inflammation, such as antibiotics or surgery, have a direct impact on vessel diameters remains to be determined.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights the clinical relevance of sigmoidal artery and vein diameters as predictive markers for complicated diverticulitis. These vascular measurements provide a reliable, non-invasive tool that can be easily incorporated into routine CT imaging, offering clinicians objective data to guide treatment decisions. By identifying patients at higher risk for complications early in the disease course, healthcare providers can intervene more aggressively when necessary, potentially preventing disease progression and improving patient outcomes. Future research should aim to validate these findings in larger, prospective studies and explore the potential for incorporating vascular measurements into existing classification systems for diverticulitis.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCT: computed tomography\u003c/p\u003e\n\u003cp\u003eROC: receiver operating characteristic\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAUC: area under the curve\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOR: Odds ratios\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCI: confidence intervals\u003c/p\u003e\n\u003cp\u003eCRP: C-reactive protein\u003c/p\u003e\n\u003cp\u003eNLR neutrophil-to-lymphocyte ratio\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIBD: inflammatory bowel disease\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study adhered to the STROBE guidelines for observational studies and was approved by the Institutional Review Board of the Hitit Univercıty Faculty of Medicine Clinical Research Ethics Committee (protocol number: 2023-105). Data were retrospectively collected from patients diagnosed with acute sigmoid diverticulitis who presented to the General Surgery Department. Ethical approval for the study was granted by the institutional review board, and patient confidentiality was rigorously safeguarded through the anonymization of all patient records in accordance with ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e For this type of study formal consent is not required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u003c/strong\u003e The dataset analyzed for this study is available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e Authors declares that they have no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The study had no funding source\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors and Affiliations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1: Hitit University, Faculty of Medicine, Department of Surgery, \u0026Ccedil;orum, Turkey\u003c/p\u003e\n\u003cp\u003e2: Hitit University, Faculty of Medicine, Department of Radiology, \u0026Ccedil;orum, Turkey\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors made substantive intellectual contributions in this study to qualify as authors. RT and OA: Conceptualization, literature review, protocol development and abstract review, data extraction, revision, and submission. İS,MK and VBT: Title, manuscript writing, Data analysis and Data Collection. NF and İS: Manuscript revision, Submission and Supervision. All authors have read and approved the final version of themanuscript, and agree with the order of presentation of the authors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eThank you.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEverhart JE, Ruhl CE. Burden of digestive diseases in the United States: Part II lower gastrointestinal diseases. Am J Gastroenterol. 2022;117(6):930\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeery AF, Crockett SD, Murphy CC, et al. Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: Update 2021. Gastroenterology. 2022;162(2):621\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBolkenstein HE, van de Wall BJ, Consten EC, et al. Long-term follow-up after elective resection for recurrent diverticulitis: Results from the DIRECT trial. Ann Surg. 2021;274(2):612\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHall J, Hardiman K, Lee S, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis. Dis Colon Rectum. 2022;65(7):802\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTursi A, Elisei W, Picchio M, et al. Vascular and inflammatory complications in acute diverticulitis: A multicenter study. Int J Colorectal Dis. 2022;37(9):1971\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSiddique SM, Kamboj AK, Jena B, et al. Vascular remodeling in diverticular disease: Insights into pathophysiology. Gastroenterol Insights. 2021;12(4):434\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHall J, Hardiman K, Lee S, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis. Dis Colon Rectum. 2022;65(7):802\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStrate LL, Morris AM. Epidemiology, pathophysiology, and treatment of diverticulitis. Gastroenterology. 2019;156(5):1282\u0026ndash;e12981.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRezapour M, Ali S, Stollman N. Diverticular disease: An update on pathogenesis and management. Gut Liver. 2018;12(2):125\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmed AM, Moahammed AT, Mattar OM, et al. Surgical treatment of diverticulitis and its complications: A systematic review and meta-analysis of randomized control trials. Surgeon. 2018;16(6):372\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHawkins AT, Wise PE, Chan T, et al. Diverticulitis: An update from the age-old paradigm. Curr Probl Surg. 2020;57:100862.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePober JS, Sessa WC. Inflammation and the blood microvascular system. Cold Spring Harb Perspect Biol. 2015;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMunie ST, Nalamati SP. Epidemiology and pathophysiology of diverticular disease. Clin Colon Rectal Surg. 2018;31:209\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMigaly J, Bafford AC, Francone TD, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of diverticulitis. Dis Colon Rectum. 2020;63(6):728\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Sigmoid Diverticulitis, Vascular Remodeling, Computed Tomography, Prognosis","lastPublishedDoi":"10.21203/rs.3.rs-5493445/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5493445/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcute sigmoid diverticulitis is a common inflammatory condition that can progress to severe complications such as abscess formation, fistulas, and perforation. While computed tomography (CT) is the gold standard for diagnosis, it offers limited prognostic information. Emerging evidence suggests that vascular changes in the sigmoidal arteries and veins may correlate with disease severity and serve as predictive markers for complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterial/Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective study analyzed 160 patients with confirmed acute sigmoid diverticulitis between May 2018 and May 2023. Patients were divided into two groups based on the presence of complications using the modified Hinchey classification: Group 1 (uncomplicated diverticulitis) and Group 2 (complicated diverticulitis). Vascular diameters were measured using contrast-enhanced CT scans, focusing on the sigmoidal arteries and veins. The study assessed the relationship between vascular diameters and disease severity using multivariate logistic regression, with receiver operating characteristic (ROC) curve analysis to determine diagnostic cut-off values.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients with complicated diverticulitis exhibited significantly larger sigmoidal artery and vein diameters compared to those with uncomplicated disease (p \u0026lt; 0.001). The optimal cut-off values for predicting complications were 3.15 mm for the sigmoidal artery and 3.85 mm for the sigmoidal vein, with sensitivities of 78% and 82%, and specificities of 76% and 81%, respectively. Multivariate analysis confirmed that increased vascular diameters and elevated neutrophil-to-lymphocyte ratio (NLR) were independent predictors of complicated diverticulitis (p \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVascular measurements of the sigmoidal arteries and veins, along with inflammatory markers, can enhance the prediction of complications in acute sigmoid diverticulitis. These measurements may serve as valuable tools for guiding treatment decisions, potentially improving patient outcomes through early identification of high-risk cases.\u003c/p\u003e","manuscriptTitle":"Assessment of Sigmoidal Artery and Vein Diameters as Predictive Markers for Complications in Acute Sigmoid Diverticulitis: A Retrospective Observational Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-28 13:41:22","doi":"10.21203/rs.3.rs-5493445/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d2a195aa-4146-4d26-8da4-a686f3dbe55c","owner":[],"postedDate":"November 28th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-06T03:53:10+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-28 13:41:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5493445","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5493445","identity":"rs-5493445","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}