1466 Diverticulitis: The Rare and Unanticipated Complication of Colonoscopy

Abstract

INTRODUCTION: Colonoscopy is a common therapeutic and diagnostic tool used for colon cancer screening and surveillance. Although considered low risk, the most common complications include hemorrhage, bowel perforation and infection with rates of 1%, 0.1% and 1.1% respectively. Other uncommon complications include splenic injury and bowel obstruction. Diverticulitis is defined as inflammation of a diverticulum and is the result of a small tears in the diverticular wall. The reported incidence of colonoscopy induced diverticulitis differs between 0.08 and 1.9 per 1000 colonoscopies. CASE DESCRIPTION/METHODS: 64-year-old male with past history of CAD, HLD and diverticulitis presented with severe abdominal pain. 6 hours before presentation, patient had undergone a screening colonoscopy with polypectomy. Patient's abdominal pain was sharp and non-radiating. He denied any associated fevers, diarrhea, nausea or vomiting. Patient however did complain of chills. Upon presentation, patient had a temperature of 102.3 °F and HR of 109. Physical exam revealed diffuse abdominal tenderness. Labs were significant for lactic acid of 3.7. WBC count was 7,900. CT scan findings suggested diverticulitis. Repeat CBC few hours later showed an up-trending WBC count (10,800). Patient was managed with IV fluids and antibiotics. He was initially kept n.p.o. and then diet was gradually advanced which he tolerated well. A day after admission, patient was tolerating oral intake well and pain had resolved. He was discharged in stable condition. DISCUSSION: A retrospective cohort studied 236,377 colonoscopies with development of acute colonic diverticulitis in 68 patients within 30 days after colonoscopy. The rate of colonoscopy induced diverticulitis in the cohort was estimated to be 10 times less than the reported rates of other complication. Past history of diverticulitis is considered to be a risk factor for development of diverticulitis. No evidence of diverticulitis specifically after polypectomy was found on literature review. In our patient, we suspect that the micro and/or macro perforations induced by polypectomy led to introduction of bacteria into the diverticular wall and subsequently to the blood stream resulting in both local and systemic manifestations. Moreover, our patient's past history of diverticulitis also increased his risk. Our case is intended to shed light on this rare but potentially serious complication of colonoscopy in patients who develop severe abdominal pain and/or fever following colonoscopy.