Abstract
BackgroundFollowing an episode of acute diverticulitis, surgical guidelines commonly advise routine colonic follow-up to rule out underlying malignancy. However, as a CT of the abdomen is frequently performed during clinical work-up, the routine need for colonic follow-up has become debated. PurposeTo evaluate the need for routine CT colonography after an episode of CT-verified uncomplicated sigmoid diverticulitis to rule out underlying colorectal malignancy. Material and methodsThis study retrospectively evaluated 312 patients routinely referred to colonic evaluation by CT colonography following an episode of acute diverticulitis. Patients were excluded if lacking diagnostic CT of the abdomen at time of diagnosis, if presenting with atypical colonic involvement, or if CT findings were suggestive of complicated disease (e.g., abscess or perforation). CT colonography exams were routinely reviewed by experienced abdominal radiology consultants on the day of the procedure. If significant polyps were detected, or if colorectal malignancy could not be excluded, patients were referred to same-day optical colonoscopy. For these patients, medical records were reviewed for optical colonoscopy results and histology reports if applicable. ResultsAmong 223 patients with CT-verified uncomplicated sigmoid diverticulitis, no patients were found to have underlying colorectal malignancy. 27 patients were referred to optical colonoscopy based on CT colonography findings. 18 patients consequently underwent polypectomy, all with either hyperplastic or adenomatous histology. ConclusionsThis study indicates that routine colonic evaluation by CT colonography following an episode of CT-verified uncomplicated sigmoid diverticulitis may be unwarranted, and should arguably be reserved for patients with protracted or atypical clinical course.
Highlights
Acute diverticulitis, an inflammation of a colonic diverticulum, is a common cause of abdominal pain in an in-hospital setting, and represents a significant burden on health care resources in developed countries [1]
This study indicates that routine colonic evaluation by cross-sectional imaging (CT) colonography following an episode of CTverified uncomplicated sigmoid diverticulitis may be unwarranted, and should arguably be reserved for patients with protracted or atypical clinical course
A total of 312 patients were referred to a CT colonography exam as follow-up for an episode of acute diverticulitis at our institution between 01.01.2012 and 31.12.2018. 16 patients were excluded due to lack of diagnostic CT of the abdomen prior to referral and 25 patients were excluded due to atypical colonic involvement
Summary
An inflammation of a colonic diverticulum, is a common cause of abdominal pain in an in-hospital setting, and represents a significant burden on health care resources in developed countries [1]. Several studies have reported an increased risk of underlying colo rectal cancer among patients presenting with acute diverticulitis [4,5,6] On this basis, surgical guidelines commonly advise routine follow-up with colonoscopy after 4–8 weeks to rule out underlying malignancy [7,8,9]. Several recent studies have found that the risk for underlying malignancy is low, and that routine colonic follow-up of uncomplicated diverticulitis should be reserved for selected patients (e.g., with protracted or atypical clinical course) [3,10, 12,13,14,15]. Conclusions: This study indicates that routine colonic evaluation by CT colonography following an episode of CTverified uncomplicated sigmoid diverticulitis may be unwarranted, and should arguably be reserved for patients with protracted or atypical clinical course
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