EP.TU.634Role of Colonoscopy in left colon diverticulitis

Aim Methods Result Conclusions

CHOICE OF THERAPEUTIC AND DIAGNOSTIC MEASURES FOR ACUTE DIVERTICULITIS OF THE COLOR INTESTINAL WITH DEVELOPMENT OF LOCAL INFLAMMATORY COMPLICATIONS

Summary: Introduction. Diverticular disease of the large intestine accounts for 30-60 % of all organ pathologies, among which acute diverticulitis is 20-60 %. The aim of the study was to select therapeutic and diagnostic measures for acute diverticulitis of the large intestine with the development of local inflammatory complications. Materials and methods. The results of treatment of 68 patients with acute diverticulitis were analyzed. Diagnostics included clinical and laboratory studies, irrigography, colonoscopy, ultrasound, computed tomography. Research results. 61.8 % of patients with Ia, Ib stages of acute diverticulitis were treated conservatively. Drainage was installed under ultrasound control into the abscess area in 10.3 % of patients with acute diverticulitis in stage Ib. Laparoscopic intervention was performed in 22.1 % of patients. Operated on emergency indications 33.8 % of patients with II, III, IV stages of acute diverticulitis from laparotomic access. Postoperative mortality was 8.7 % of cases. Conclusions:1. Comprehensive assessment of clinical, radiological, endoscopic data, ultrasound, CT data allows to establish the clinical form and stage of acute colon diverticulitis and to choose the correct treatment tactics. 2. Multicomponent drug therapy is a rational method of treatment in patients with stage Ia, Ib acute diverticulitis. 3. Surgical treatment is indicated in acute diverticulitis complicated by perforation and peritonitis, profuse intestinal bleeding or intestinal obstruction caused by cicatricial stricture. 4. The proposed therapeutic and diagnostic algorithm for acute diverticulitis of the large intestine with the development of pyoinflammatory complications should be introduced into the practice of general surgical departments.

Routine colonoscopy may be needed for uncomplicated acute right colonic diverticulitis

Background Routine colonoscopy is recommended to determine the coexistence of colon cancer after medical treatment for colon diverticulitis. However, in the case of uncomplicated diverticulitis diagnosed by computed tomography, the clinical relevance of routine follow-up colonoscopy has recently been debated. Yet, the role of follow-up colonoscopy for right colon diverticulitis, which tends to develop at a younger age than left colon diverticulitis, has not been specifically evaluated. Therefore, we aimed to evaluate the incidence of right colon cancer or colonic adenomatous polyps, detected by routine colonoscopy, after conservative management of acute uncomplicated right colon diverticulitis. Methods Patients with uncomplicated right colon diverticulitis (modified Hinchey stage Ia) diagnosed by computed tomography imaging, between 2011 and 2017, and who underwent follow-up colonoscopy surveillance after treatment were included. The primary outcome was the incidence of colon cancer, with the detection rate of adenoma being the secondary outcome. Information for analysis was retrieved retrospectively from patients’ medical records. Results The study group included 330 consecutive patients, with a mean age of 41.9 years, and 51.9% being men. For the primary outcome, the rate of colon cancer on follow-up colonoscopy was 0.3% (1/330 cases). The rate of adenoma detection was 20.9% (69/330 cases) and advanced adenoma (> 10 mm in diameter; or exhibiting a > 25% villous component or severe dysplasia), including colon cancer, was observed in 9 patients (2.7%). Conclusions In patients with acute uncomplicated right colonic diverticulitis, routine colonoscopy after conservative treatment may be necessary because although the colon cancer detection rate is low, it is possible to detect advanced colon adenoma.

Routine colonoscopy may be needed for uncomplicated acute right colonic diverticulitis

BACKGROUND: Routine colonoscopy is recommended to determine the coexistence of colon cancer after medical treatment for colon diverticulitis. However, in the case of uncomplicated diverticulitis diagnosed by computed tomography imaging, the clinical relevance of routine follow-up colonoscopy has recently been debated. Yet, the role of follow-up colonoscopy for right colon diverticulitis, which tends to develop at a younger age than left colon diverticulitis, has not been specifically evaluated. Therefore, our aim in this study was to evaluate the incidence of right colon cancer or colonic adenomatous polyps, detected by routine colonoscopy, after conservative management of acute uncomplicated right colon diverticulitis. METHODS: Included were patients with uncomplicated right colon diverticulitis diagnosed by computed tomography imaging, between 2011 and 2017, and who underwent follow-up colonoscopy surveillance after treatment. The primary outcome was the incidence of colon cancer, with the detection rate of adenoma being the secondary outcome. Information for analysis was retrieved, retrospectively, from patients’ medical records. RESULTS: The study group included 330 consecutive patients, with a mean age of 41.9 years, and 51.9% being men. For the primary outcome, the rate of colon cancer on follow-up colonoscopy was 0.3% (1/330 cases). The rate of adenoma detection was 20.9% (69/330 cases), with advanced adenoma, including colon cancer, observed in 9 patients (2.7%). CONCLUSION: In patients with acute uncomplicated right colonic diverticulitis, routine colonoscopy after conservative treatment may be necessary because although the colon cancer detection rate is low, it is possible to detect advanced colon adenoma.