Routine Colonoscopy after Diverticulitis Should not be Performed to Rule Out Colorectal Cancer

Abstract

Introduction: Diverticulitis is a clinical diagnosis generally confirmed by a radiological examination. Guidelines recommend routine screening for colorectal cancer after the acute phase. Aim: Patients diagnosed with diverticulitis were studied in order to gain more information on presence of concomitant abnormalities. Material and methods: Inclusion criterion was the radiologic diagnosis of diverticulitis. All consecutive requests for ultrasound and/ or CT-scan of the abdomen in a three year period, with Diverticulitis mentioned in application were included. If diverticulitis was diagnosed, than this specific investigation was included in the present study. Hospital records were searched for the presence of endoscopic investigation. Results: In the three year period 1410 consecutive ultrasound investigation and/or CT-scans of the abdomen were performed. After exclusions 198 patients remained with the radiological confirmed diagnosis of diverticulitis. Of these patients 127 (64%) underwent an additional endoscopy. Seventy one patients (36%) did not undergo a colonoscopy. There was no difference in gender or in age between both groups. Colonoscopy showed additional abnormalities in 22 (17.3%) of the patients. These were hyperplastic polyp(s) in six, adenomatous polyp(s) in nine, polyps without histological confirmation in three and segmental colitis in three. Two male patients were diagnosed with sigmoid cancer. Both had non-subsiding diverticulitis with abscess formation at the location of the tumor. Conclusion: It is safe to omit colonoscopy after an episode of uncomplicated diverticulitis. Only in cases of complications or persistent complaints cancer should be part of the differential diagnosis and a subsequent colonoscopy should be performed.