Is routine colonoscopy necessary for patients who have an unequivocal computerised tomography diagnosis of acute diverticulitis?

2020 ◽  
pp. 003693302094922
Author(s):  
Hisham El Zanati ◽  
Adriel Chen ◽  
Abdulaziz Attiya ◽  
Edward Leung
Keyword(s):  
Acute Diverticulitis ◽  
Complicated Diverticulitis ◽  
Ct Diagnosis ◽  
Colorectal Malignancy ◽  
Uncomplicated Diverticulitis ◽  
Underlying Malignancy ◽  
Diseased Segment ◽  
Surgical Unit ◽  
Emergency Resection

Aims To assess the incidence of underlying colorectal malignancy in patients admitted as an emergency with a CT diagnosis of acute diverticulitis and determine the need for routine follow up colonoscopy Methods A retrospective study was performed on all patients who had been admitted to our surgical unit with CT diagnosed diverticulitis from September 2016 to September 2018 (n = 125). Results 11 patients (8.8%) required emergency resection with no underlying malignancy found. 76 patients (61%) had a follow up colonoscopy after being discharged. 4 patients were found to have an underlying colorectal malignancy, one of them suspected on CT and another an incidentally detected caecal polyp cancer. Therefore 3/87(3.4%) had an unexpected cancer diagnosis and all those in the diseased segment were within complicated diverticulitis. Conclusion Nowadays, multi-slice CT scanners are so good at giving an accurate assessment of colonic pathology. In our study, 96.6% of the patients with a CT diagnosis of acute diverticulitis had no underlying malignancy in the diseased segment with all the cancers within complicated diverticulitis. With such a low yield of underlying malignancy in uncomplicated diverticulitis, we question the need for routine follow up colonoscopy when there is no CT suspicion of malignancy in these patients

EP.FRI.1020 The necessity of colonoscopy to rule out colorectal malignancy after computerised tomography proven diagnosis of acute diverticulitis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
S Barman ◽  
L Meney ◽  
C Boyle ◽  
C Collison ◽  
K Shalli
Keyword(s):  
Ct Scan ◽  
Normal Population ◽  
Acute Diverticulitis ◽  
Bowel Cancer ◽  
Complicated Diverticulitis ◽  
Uncomplicated Diverticulitis ◽  
Number Of Patients ◽  
Endoscopic Assessment ◽  
Rule Out

Abstract Introduction The current Royal College of Surgeons commissioning guideline on colonic diverticular disease suggests that patients should undergo endoscopic evaluation of the colonic lumen after an episode of computed tomography (CT) proven acute diverticulitis to rule out malignancy. The necessity of routine endoscopic assessment of CT proven diverticulitis remains debatable. Aim To establish whether routine endoscopic assessment should be carried out for patients after an episode of acute diverticulitis. Method Data was collected retrospectively from all patients diagnosed with acute diverticulitis on CT and who subsequently had follow up endoscopic assessment from January to July 2019. Results Total number of patients were 64.Median age of the cohort was 58.Of all patients, 48 had diagnosis of uncomplicated diverticulitis whereas 16 patients had diagnosis of complicated diverticulitis on CT scan. All patients had follow up colonoscopy after an acute attack with following findings: 2 patients had no pathology, 56 patients had diagnosis of only diverticulosis, 4 patients had both diverticulosis and polyps and 2 patients had bowel cancer. All 4 cases of polyps had benign pathology and uncomplicated diverticulitis on CT scan. Two bowel cancer patients, one had complicated diverticulitis with thickening of proximal sigmoid and the other patient had abnormal sigmoid colon suggestive of malignancy on CT scan. Conclusion Recent meta-analysis showed no difference between diverticulitis and normal population group in terms of risk of bowel cancer. Routine colonoscopy may not be appropriate in patients with acute uncomplicated diverticulitis but endoscopic assessment after an episode of complicated diverticulitis is necessary.

Operative Surgery is Rarely Required in the Acute Management of Diverticulitis in the Modern Era

2020 ◽  
Vol 86 (4) ◽  
pp. 308-312 ◽  
Author(s):  
Bhanuka Dissanayake ◽  
Matthew J. Burstow ◽  
Arunan Jeyakumar ◽  
Peter J. Yuide ◽  
Justin Gundara ◽  
...  
Keyword(s):  
Percutaneous Drainage ◽  
Acute Diverticulitis ◽  
White Cell Count ◽  
Demographic Data ◽  
Length Of Hospital Stay ◽  
Complicated Diverticulitis ◽  
Related Factors ◽  
Uncomplicated Diverticulitis ◽  
Operative Surgery ◽  
Surgical Unit

Acute diverticulitis is an emergency surgical condition that is commonly managed via an acute surgical unit model. Operative surgery is indicated in selected situations including generalized peritonitis or fistulous disease; however, limited data exist on how borderline patients potentially needing surgery may be salvaged by close clinical management with modern interventional techniques. The aims of the study were to identify the operative surgery rates in acute diverticulitis and predictors for identifying patients with complicated diverticulitis. Retrospective data collection was performed on a prospectively held database at a high-volume acute surgical unit at Logan Hospital, Queensland. Patient demographic data, disease-related factors, and treatment-related factors were collected for reporting and analysis. Over three years (2016–2018), 201 patients (64%) were admitted with uncomplicated diverticulitis and 113 patients (36%) with complicated diverticulitis. An observable downward trend was noted in the number of yearly admissions for uncomplicated diverticulitis. Complicated diverticulitis was associated with male gender ( P = 0.039), increased length of hospital stay ( P < 0.001), temperature ≥37.5 ( P = 0.025), increased white cell count ( P < 0.001), and elevated C-reactive protein ( P < 0.001). Twelve patients (11%) with complicated diverticulitis initially failed conservative management. Seven patients (6%) underwent a definitive Hartmann's procedure, and 5 patients (4%) underwent percutaneous drainage of abscesses. Acute diverticulitis can be safely managed nonoperatively by medical therapy and percutaneous drainage of abscesses, with surgery reserved for patients with complicated diver-ticulitis with sepsis or peritonitis.

EP.FRI.971 Is routine endoscopic evaluation of the colon necessary after an episode of acute diverticulitis?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Adiba Hussain ◽  
Akash Dhanri ◽  
Rehma Sayed ◽  
Ahmed Saleh ◽  
Arin Saha ◽  
...  
Keyword(s):  
Flexible Sigmoidoscopy ◽  
Acute Diverticulitis ◽  
Ct Scanning ◽  
Complicated Diverticulitis ◽  
Wall Thickening ◽  
Endoscopic Evaluation ◽  
Uncomplicated Diverticulitis ◽  
Underlying Malignancy ◽  
Future Clinical Practice ◽  
Fat Stranding

Abstract Aim Currently standard practice is for patients diagnosed with diverticulitis to undergo endoscopic evaluation of the colon following the acute episode. The primary aim of endoscopy is to exclude underlying malignancy which may have been undetectable on initial CT scanning. We aim to determine if endoscopic evaluation of the colon is necessary for all patients. Methods All patients with CT proven diverticulitis were included between May 2017 and July 2018. Medical records, CT and endoscopy reports of 154 consecutive patients were retrospectively reviewed. Based on the CT reports, diverticulitis was classified as either uncomplicated (colonic wall thickening, pericolic fat stranding) or complicated (perforation, abscess, generalised free air and/or fluid). Results There were 154 patients included in the study. 59% percent were male. Median age at the time of diagnosis was 56 years old.  There were 114 patients with uncomplicated and 40 patients with complicated diverticulitis. 79 patients (50 flexible sigmoidoscopy, 29 colonoscopy) with uncomplicated diverticulitis and 21 patients (15 flexible sigmoidoscopy, 6 colonoscopy) with complicated diverticulitis underwent endoscopy. Of the patients that underwent endoscopy, one patient (1.3%) with uncomplicated disease and one patient (4.8%) with complicated disease were found to have colorectal cancer (both rectal). Neither of these were associated with the diverticular segment. Conclusions Our data shows that routine endoscopic evaluation of the colon after an episode of acute diverticulitis may not be necessary in all cases. Patient numbers in this study are small therefore further work is required to draw conclusions which could influence future clinical practice.

scholarly journals How to use administrative data for surgical outcomes in acute diverticulitis

2016 ◽  
Vol 1 (1) ◽  
pp. 15 ◽  
Author(s):  
Michael K-Y Hong ◽  
Anita R Skandarajah ◽  
Omar D Faiz ◽  
Ian P Hayes
Keyword(s):  
New Zealand ◽  
Administrative Data ◽  
Surgical Outcomes ◽  
Acute Diverticulitis ◽  
Complicated Diverticulitis ◽  
Administrative Database ◽  
Coding System ◽  
Diverticular Bleeding ◽  
Predictive Values ◽  
Uncomplicated Diverticulitis

<p>The measurement of quality outcomes is crucial in surgical care. Administrative data are increasingly used but their ability to provide clinically useful information is reliant on how closely the coding can define a particular cohort.        In acute admissions for diverticular disease, it is important to differentiate between complicated and uncomplicated diverticulitis, and between diverticulitis and diverticular bleeding. We aim to develop a method to define clinically relevant cohorts of patients from an administrative database in acute diverticulitis. Codes for acute diverticulitis were found from the ICD-10-AM (Australia and New Zealand) coding system, and the accuracy was established with retrospective chart review and cross-referenced with a clinical database at a single institution. Coding of non-diverticular and missed diverticular  cases was examined to determine non-diverticular codes that could differentiate these cases. These were combined into  logic algorithms designed to differentiate between uncomplicated and complicated diverticulitis admissions derived from   an administrative database. Specific K57 diverticular codes possessed sensitivity and positive predictive values of 0.92    and 0.69 for uncomplicated diverticulitis, respectively, with 0.61 and 0.92 for complicated diverticulitis, respectively, based on 153 cases. Most of the missing cases were usually complicated diverticulitis whilst some cases coded incorrectly  as uncomplicated diverticulitis were often found as undifferentiated abdominal pain. Diagnostic codes combined into algorithms that accounted for predictable variations improved cohort definition. In conclusion, algorithms with combined codes improved definitions of clinically relevant cohorts for acute diverticulitis from an Australian or New Zealand administrative database. This method may be used to develop logic algorithms for other surgical conditions and enable widespread measurement of relevant surgical outcomes.</p>

scholarly journals Increasing trend in admission rates and costs for acute diverticulitis during 2005–2015: real-life data from the Abruzzo Region

2018 ◽  
Vol 11 ◽  
pp. 175628481879150 ◽  
Author(s):  
Simona Cammarota ◽  
Martina Cargiolli ◽  
Paolo Andreozzi ◽  
Bernardo Toraldo ◽  
Anna Citarella ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Financial Burden ◽  
Acute Diverticulitis ◽  
Real Life ◽  
Complicated Diverticulitis ◽  
Admission Rates ◽  
Uncomplicated Diverticulitis ◽  
Real Life Data ◽  
Epidemiological Trend ◽  
Abruzzo Region

Background: Scarce data are available on the epidemiological trend of diverticulitis and its financial burden in Italy. The aim of this work was to explore a potential variation in the rate and costs of hospital admissions for uncomplicated and complicated diverticulitis over the last decade. Methods: We selected all hospitalizations for diverticulitis of residents in the Abruzzo Region, Italy between 2005 and 2015. Age-standardized hospitalization rates (HRs) per 100,000 inhabitants for overall, uncomplicated and complicated diverticulitis were calculated. A linear model on the log of the age-standardized rates was used to calculate annual percentage changes (APC). Costs were derived from the official DRG tariff. Results: From 2005 to 2015, the HR for acute diverticulitis increased from 38.9 to 45.2 per 100,000 inhabitants (APC + 1.9%). The HR for complicated diverticulitis increased from 5.9 to 13.3 (APC + 7.6%), whereas it remained stable for uncomplicated diverticulitis. The mean hospital cost was 1.8-times higher for complicated diverticulitis compared with that for uncomplicated disease and 3.5-times higher for patients with a surgery stay compared with that for patients with a medical stay. Conclusion: During the last decade, in the Abruzzo Region, the HRs for diverticulitis and their costs increased significantly, mainly due to disease complications. Further studies are needed to explore strategies to prevent complications and to realise cost-saving policies.

Diagnosis and Management of Acute Diverticulitis

2019 ◽  
Author(s):  
Tiffany K Weidner ◽  
John T Kidwell ◽  
David A Etzioni
Keyword(s):  
United States ◽  
Acute Diverticulitis ◽  
The United States ◽  
Complicated Diverticulitis ◽  
Perforated Diverticulitis ◽  
Uncomplicated Diverticulitis ◽  
Urgent Surgery ◽  
Colonic Fistula ◽  
Surgical Evaluation ◽  
Acute Uncomplicated Diverticulitis

Diverticulitis is the cause of 300,000 inpatient admissions in the United States each year. Surgical evaluation and treatment are commonly required for the treatment of diverticulitis. This chapter discusses the diagnosis, triage, and treatment of acute diverticulitis. Medical treatment, as well as the indications for surgical treatment for diverticulitis, is discussed. Current controversies, including the need for antibiotics for a patient with acute uncomplicated diverticulitis, necessity of colonoscopy after resolution of an acute episode, and indications for urgent surgery, are reviewed.  This review contains 10 figures, 3 tables, and 67 references. keywords: acute diverticulitis, colonic fistula, complicated diverticulitis, diverticular abscess, diverticular disease, diverticulitis, diverticulosis, perforated diverticulitis, uncomplicated diverticulitis

Diagnostic Accuracy of Point-of-Care Ultrasound Integrated into Clinical Examination for Acute Diverticulitis: A Prospective Multicenter Study

2020 ◽  
Author(s):  
Peiman Nazerian ◽  
Chiara Gigli ◽  
Emilia Donnarumma ◽  
Ersilia de Curtis ◽  
Andrea Bribani ◽  
...  
Keyword(s):  
Ct Scan ◽  
Point Of Care ◽  
Acute Diverticulitis ◽  
Final Diagnosis ◽  
Complicated Diverticulitis ◽  
Point Of Care Ultrasound ◽  
Sonographic Assessment ◽  
The One ◽  
Low Sensitivity

Abstract Purpose Diverticulitis is a common cause of abdominal pain and CT scan is commonly used for its diagnosis in the emergency department (ED). The diagnostic performance of point-of-care ultrasound (POCUS) integrated into a clinical exam for diverticulitis is still not established. We evaluate the accuracy of clinical-sonographic assessment for the diagnosis of diverticulitis and whether POCUS could improve the selection of patients needing CT scan for complicated diverticulitis. Materials and Methods This is a multicentric observational study involving adult patients suspected of having diverticulitis presenting at 4 EDs. 21 sonographer physicians were asked to diagnose diverticulitis and complicated diverticulitis based on clinical-sonographic assessment. The final diagnosis was established by two reviewers, blinded to POCUS, based on data collected during the one-month follow-up comprehensive CT scan. Results Among 393 enrolled patients, 218 (55.5 %) were diagnosed with diverticulitis and 33 (8 %) had complicated diverticulitis. The time to diagnosis by the sonographer physicians was shorter compared to standard care (97 ± 102 vs. 330 ± 319 minutes, p < 0.001). Clinical-sonographic assessment showed optimal sensitivity (92.7 %) and specificity (90.9 %) for diverticulitis. However, the sensitivity (50 %) for complicated diverticulitis was low. The sonographer physician would have proceeded to CT scan in 194 (49.4 %) patients and the CT scan request compared to the final diagnosis of complicated diverticulitis demonstrated 94 % sensitivity. Conclusion Clinical-sonographic assessment is rapid and accurate for the diagnosis of diverticulitis. Even if POCUS has low sensitivity for complicated diverticulitis, it can be used to safely select patients needing CT.

Tumour Characteristics of Patients with Colorectal Cancer after Acute Uncomplicated Diverticulitis

2018 ◽  
Vol 36 (5) ◽  
pp. 362-368 ◽  
Author(s):  
Winesh Ramphal ◽  
Jennifer M.J. Schreinemakers ◽  
Tom C.J. Seerden ◽  
Paul D. Gobardhan
Keyword(s):  
Colorectal Cancer ◽  
Observational Study ◽  
Primary Endpoint ◽  
Poor Prognosis ◽  
Acute Diverticulitis ◽  
Uncomplicated Diverticulitis ◽  
Tumour Characteristics ◽  
Epidemiological Characteristics ◽  
Acute Uncomplicated Diverticulitis

Background: The association between diverticulitis and colorectal cancer (CRC) remains unclear, though both share epidemiological characteristics. The aim of this study was to investigate whether there is higher risk for CRC after an episode of uncomplicated diverticulitis. Furthermore, in cases of CRC, we sought to determine specific tumour characteristics. Methods: This retrospective observational study includes patients with acute diverticulitis (Hinchey 0 and 1) who were conservatively treated with or without antibiotics between 2008 and 2013. Patients with endoscopic follow-up were included for analysis. Tumour characteristics of patients diagnosed with CRC during colonoscopic follow-up according to patients’ presentation of alarm symptoms were considered to be the primary endpoint. Results: A total of 977 patients were conservatively treated for an episode of acute diverticulitis, 645 of whom underwent colonoscopy during follow-up. Ten patients were diagnosed with CRC, nine of whom exhibited alarm symptoms. One patient was diagnosed with stage I disease, 4 had stage II, and 5 had stage III disease. Conclusions: This study strongly suggests that even though CRC is rare after uncomplicated diverticulitis, in cases of alarm symptoms, a colonoscopy is indicated. In cases where CRC is diagnosed, it is often advanced with a higher TNM stage and poor prognosis.

scholarly journals Conservative Management of Complicated Colonic Diverticulitis in Early and Late Elderly

Medicina ◽  
2021 ◽  
Vol 58 (1) ◽  
pp. 29
Author(s):  
Gennaro Perrone ◽  
Mario Giuffrida ◽  
Elena Bonati ◽  
Gabriele Luciano Petracca ◽  
Antonio Tarasconi ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Elderly Patients ◽  
Conservative Management ◽  
Acute Diverticulitis ◽  
The Elderly ◽  
Complicated Diverticulitis ◽  
First Episode ◽  
Colonic Diverticulitis ◽  
Acute Colonic Diverticulitis

Background and Objectives: The management of complicated diverticulitis in the elderly can be a challenge and initial non-operative treatment remains controversial. In this study, we investigate the effectiveness of conservative treatment in elderly people after the first episode of complicated diverticulitis. Materials and Methods: This retrospective single-centre study describes 71 cases of elderly patients with complicated acute colonic diverticulitis treated with conservative management at Parma University Hospital from 1 January 2012 to 31 December 2019. Diverticulitis severity was staged according to WSES CT driven classification for acute diverticulitis. Patients was divided into two groups: early (65–74 yo) and late elderly (>75 yo). Results: We enrolled 71 elderly patients conservatively treated for complicated acute colonic diverticulitis, 25 males and 46 females. The mean age was 74.78 ± 6.8 years (range 65–92). Localized abdominal pain and fever were the most common symptoms reported in 34 cases (47.88%). Average white cells count was 10.04 ± 5.05 × 109/L in the early elderly group and 11.24 ± 7.89 in the late elderly group. CRP was elevated in 29 (78.3%) cases in early elderly and in 23 late elderly patients (67.6%). A CT scan of the abdomen was performed in every case (100%). Almost all patients were treated with bowel rest and antibiotics (95.7%). Average length of stay was 7.74 ± 7.1 days (range 1–48). Thirty-day hospital readmission and mortality were not reported. Average follow-up was 52.32 ± 31.8 months. During follow-up, home therapy was prescribed in 48 cases (67.6%). New episodes of acute diverticulitis were reported in 20 patients (28.1%), elevated WBC and chronic NSAID therapy were related to a higher risk of recurrence in early elderly patients (p < 0.05). Stage IIb-III with elevated WBC during first episode, had a higher recurrence rate compared to the other CT-stage (p = 0.006). Conclusions: The management of ACD in the elderly can be a challenge. Conservative treatment is safe and effective in older patients, avoiding unnecessary surgery that can lead to unexpected complications due to co-morbidities.

scholarly journals The use of biochemical markers in complicated and uncomplicated acute diverticulitis

2018 ◽  
Author(s):  
Dulitha Kumarasinghe ◽  
Assad Zahid ◽  
Greg O'Grady ◽  
Timothy Leow ◽  
Tabrez Sheriff ◽  
...  
Keyword(s):  
Cell Count ◽  
Acute Diverticulitis ◽  
White Cell Count ◽  
Complicated Diverticulitis ◽  
White Cell ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Uncomplicated Diverticulitis ◽  
Significant Difference ◽  
Post Hoc

Abstract BACKGROUND: Diverticulosis is extremely common in western society. A recent study has shown that outpatient, non-antibiotic management of acute uncomplicated diverticulitis may be a feasible and safe option. However the ability to identify these patients is still difficult. This study explores the ability of white cell count, C-reactive protein and bilirubin in differentiating patients with complicated and uncomplicated diverticulitis as well as progression to surgical intervention. METHODS: This is a retrospective study of patients admitted with acute diverticulitis over a 5-year period (2009-2014) at a single institution in Australia. Patients were classified into three groups; uncomplicated diverticulitis, complicated diverticulitis without surgery and complicated diverticulitis with surgery. ANOVA and Bonferroni's post-hoc analyses were used to compare markers across the groups. RESULTS: A total of 541 patients met the inclusion criteria for this study. One-way ANOVA showed a significant difference in white cell count (p&lt;0.0001), C-reactive protein (p&lt;0.0001) and bilirubin (p=0.0006) between all three groups. Post-hoc analyses showed a significant difference in white cell count, C-reactive protein and bilirubin when comparing uncomplicated diverticulitis against complicated diverticulitis without surgery (p&lt;0.05) and complicated diverticulitis with surgery (p&lt;0.05). White cell count also showed a significant difference when comparing complicated diverticulitis without surgery and complicated diverticulitis with surgery (p&lt;0.05). CONCLUSIONS: White cell count, C-reactive protein and bilirubin can distinguish between uncomplicated and complicated diverticulitis.

Sign in / Sign up

Export Citation Format

Share Document