Introduction Traditionally, it is recommended that the colon be evaluated after an episode of acute diverticulitis to exclude underlying pathologies such as malignancy. However, the necessity of this has been questioned in this era of frequent use of contrast-enhanced multidetector computed tomography (CT), which itself is a moderately sensitive test for colorectal cancer, to diagnose acute diverticulitis. This study aimed to determine the yield of malignancy from subsequent follow-up investigations or treatments in patients after an episode of CT-proven acute diverticulitis.
Methods This was a retrospective study of patients with acute diverticulitis as diagnosed on CT at a moderately-sized district general hospital between January 2007 and December 2011. Uncomplicated diverticulitis was defined as the presence of colonic diverticular disease with localised colonic wall thickening and/or inflammation of pericolic fat. Complicated diverticulitis was defined as the additional presence of abscess, obstruction, fistula or evidence of perforation.
Results A total of 64 patients were diagnosed with acute diverticulitis on contrast-enhanced CT. Thirty-five patients had uncomplicated diverticulitis and 29 patients had complicated diverticulitis.
The follow-up of patients with uncomplicated disease were as follows: flexible sigmoidoscopy (10), colonoscopy (4), CT colonography (2) and barium enema (4). Two patients underwent surgery. All investigations or treatments confirmed diverticular disease. None of them showed underlying malignancy. Incidental findings at the diseased sites were detected in 4 patients. Three of them had polyps and one had an aphthous ulcer. Of the patients with polyps, one had a tubular adenoma greater than 10mm, one had a 2mm tubular adenoma with low-grade dysplasia and one had an inflammatory polyp. The biopsy of the patient with the ulcer was normal. The remaining 13 patients had no follow-up and none of them were known to have returned with malignancy.
The follow-up of patients with complicated disease were as follows: flexible sigmoidoscopy (9), colonoscopy (4), CT colonography (1) and barium enema (5). Six patients had surgery. All investigations or treatments confirmed diverticular disease with no evidence of underlying malignancy. A patient who underwent surgery incidentally had hyperplastic polyps in the sigmoid colon specimen. Four patients had no follow-up and none of them were known to have developed malignancy.
Conclusion The yield of malignancy as an underlying pathology was nil in both cohorts. Routine investigation of the colonic lumen after an episode of acute diverticulitis in this era of widespread CT use may not be necessary in the absence of other sinister indications. Limited resources may be better utilised for other patients with greater risk of colorectal cancer.
Disclosure of Interest None Declared
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