The need for routine colonoscopy after acute diverticulitis revisited

Abstract

Background: The utility of routine outpatient colonoscopy after the conservative management of complicated and uncomplicated colonic diverticulitis has become questionable. Recent literature suggests this time-honored practice after uncomplicated diverticulitis is to be of little benefit, although uncertainty still persists regarding complicated diverticulitis. Objective: We analysed the rates of benign and malignant pathology identified on colonoscopy after conservatively managed uncomplicated and complicated diverticulitis in a hospital where such colonoscopies have been routine practice. Design: A retrospective cohort study was conducted. Setting: Gold Coast Hospital, Southport, Queensland, Australia. Patients and Methods: All patients who were admitted to the Gold Coast Hospital, Southport, Queensland, Australia, between June 2007 and June 2010 diagnosed with acute uncomplicated and complicated diverticulitis were included in the study. The patients were followed up and colonoscopy reports and histology results obtained. Main Outcome Measures: Benign and malignant pathology post uncomplicated and complicated diverticulitis. Sample Size: 144 patients were eligible for inclusion. Results: Between June 2007 and June 2010, 1073 patients were hospitalized with an admission diagnosis coding for diverticulitis. Of these, 144 patients had a computed tomography (CT) which confirmed the diagnosis of acute diverticulitis. Complete colonoscopy and histology data were obtained for 107 of these patients. Of these, 32 patients (29.91%) had pathology found at colonoscopy. One patient (0.9%) was found to have adenocarcinoma of the colon. Conclusion: Colonoscopy follow-up for acute diverticulitis has remained acceptable in many units to exclude alternate colonic pathology. However, recent literature has questioned the utility of this practice. This study – in keeping with this growing body of international literature – found the rate of synchronous/alternative pathology to be comparable to that of asymptomatic patient populations. Routine colonoscopies after uncomplicated colonic diverticulitis confidently diagnosed with a CT scan, therefore, cannot be justified. Limitations: Retrospective nature and sample size. Conflict of Interest: None.