Skip to main content

Advertisement

SpringerLink
Log in

Colonoscopy-induced acute diverticulitis: myth or reality?

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Colonoscopy in patients with diverticulosis can be technically challenging and limited data exist relating to the risk of post-colonoscopy diverticulitis. Our aim was to evaluate the incidence, management, and outcomes of acute diverticulitis following colonoscopy.

Methods

Study design is retrospective cohort study. Data were gathered by conducting an automated search of the electronic patient database using current procedural terminology and ICD-9 codes. Patients who underwent a colonoscopy from 2003 to 2012 were reviewed to find patients who developed acute diverticulitis within 30 days after colonoscopy. Patient demographics and colonoscopy-related outcomes were documented, which include interval between colonoscopy and diverticulitis, colonoscopy indication, simultaneous colonoscopic interventions, and follow-up after colonoscopy.

Results

From 236,377 colonoscopies performed during the study period, 68 patients (mean age 56 years) developed post-colonoscopy diverticulitis (0.029%; 2.9 per 10,000 colonoscopies). Incomplete colonoscopies were more frequent among patients with a history of previous diverticulitis [n = 10 (29%) vs. n = 3 (9%), p = 0.03]. Mean time to develop diverticulitis after colonoscopy was 12 ± 8 days, and 30 (44%) patients required hospitalization. 34 (50%) patients had a history of diverticulitis prior to colonoscopy. Among those patients, 14 underwent colonoscopy with an indication of surveillance for previous disease. When colonoscopy was performed within 6 weeks of a diverticulitis attack, surgical intervention was required more often when compared with colonoscopies performed after 6 weeks of an acute attack [n = 6 (100%) vs. n = 10 (36%), p = 0.006]. 6 (9%) out of 68 patients received emergency surgical treatment. 15 (24%) out of 62 patients who had non-surgical treatment initially underwent an elective sigmoidectomy at a later date. Recurrent diverticulitis developed in 16 (23%) patients after post-colonoscopy diverticulitis.

Conclusions

Post-colonoscopy diverticulitis is a rare, but potentially serious complication. Although a rare entity, possibility of this complication should be kept in mind in patients presenting with symptoms after colonoscopy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM (2009) American college of gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol 104(3):739–750

    Article  PubMed  Google Scholar 

  2. Ko CW, Riffle S, Michaels L, Morris C, Holub J, Shapiro JA, Ciol MA, Kimmey MB, Seeff LC, Lieberman D (2010) Serious complications within 30 days of screening and surveillance colonoscopy are uncommon. Clin Gastroenterol Hepatol 8(2):166–173

    Article  Google Scholar 

  3. Levin TR, Zhao W, Conell C, Seeff LC, Manninen DL, Shapiro JA, Schulman J (2006) Complications of colonoscopy in an integrated health care delivery system. Ann Intern Med 145(12):880–886

    Article  PubMed  Google Scholar 

  4. Rutter CM, Johnson E, Miglioretti DL, Mandelson MT, Inadomi J, Buist DS (2012) Adverse events after screening and follow-up colonoscopy. Cancer Causes Control 23(2):289–296

    Article  PubMed  Google Scholar 

  5. Singh H, Penfold RB, DeCoster C, Kaita L, Proulx C, Taylor G, Bernstein CN, Moffatt M (2009) Colonoscopy and its complications across a Canadian regional health authority. Gastrointest Endosc 69(3 Pt 2):665–671

    Google Scholar 

  6. Levin TR, Conell C, Shapiro JA, Chazan SG, Nadel MR, Selby JV (2002) Complications of screening flexible sigmoidoscopy. Gastroenterology 123(6):1786–1792

    Article  PubMed  Google Scholar 

  7. Church J (2013) Complications of colonoscopy. Gastroenterol Clin N Am 42(3):639–657

    Article  Google Scholar 

  8. Fisher DA, Maple JT, Ben-Menachem T, Cash BD, Decker GA, Early DS, Evans JA, Fanelli RD, Fukami N, Hwang JH, Jain R, Jue TL, Khan KM, Malpas PM, Sharaf RN, Shergill AK, Dominitz JA (2011) Complications of colonoscopy. Gastrointest Endosc 74(4):745–752

    Article  Google Scholar 

  9. Whitlock EP, Lin JS, Liles E, Beil TL, Fu R (2008) Screening for colorectal cancer: a targeted, updated systematic review for the US preventive services task force. Ann Intern Med 149(9):638–658

    Article  PubMed  Google Scholar 

  10. Lahat A, Yanai H, Menachem Y, Avidan B, Bar-Meir S (2007) The feasibility and risk of early colonoscopy in acute diverticulitis: a prospective controlled study. Endoscopy 39(06):521–524

    Article  PubMed  CAS  Google Scholar 

  11. Church JM. (1994) Complete colonoscopy: how often? and if not, why not?. Am J Gastroenterol 89(4):556–560

    Google Scholar 

  12. Lahat A, Yanai H, Sakhnini E, Menachem Y, Bar-Meir S (2008) Role of colonoscopy in patients with persistent acute diverticulitis. World J Gastroenterol 14(17):2763–2766

    Article  PubMed  PubMed Central  Google Scholar 

  13. Schmilovitz-Weiss H, Yalunin E, Boaz M, Sehayek-Shabbat V, Levin I, Chervinski A, Atar E, Niv Y, Shirin H (2012) Does a colonoscopy after acute diverticulitis affect its management?: a single center experience. J Clin Gastroenterol 46(4):317–320

    Article  Google Scholar 

  14. Westwood DA, Eglinton TW, Frizelle FA (2011) Routine colonoscopy following acute uncomplicated diverticulitis. Br J Surg 98(11):1630–1634

    Article  PubMed  CAS  Google Scholar 

  15. Walker AS, Bingham JR, Janssen KM, Johnson EK, Maykel JA, Ocampo O, Gonzalez JP, Steele SR (2016) Colonoscopy after Hinchey I and II left-sided diverticulitis: utility or futility? Am J Surg 212(5):837–843

    Article  PubMed  Google Scholar 

  16. de Vries HS, Boerma D, Timmer R, van Ramshorst B, Dieleman LA, van Westreenen HL (2014) Routine colonoscopy is not required in uncomplicated diverticulitis: a systematic review. Surg Endosc 28:2039–2047

    Article  PubMed  Google Scholar 

  17. Stocchi L (2010) Current indications and role of surgery in the management of sigmoid diverticulitis. World J Gastroenterol 16(7):804–817

    PubMed  PubMed Central  Google Scholar 

  18. Jacobs DO (2007) Diverticulitis. N Engl J Med 357(20):2057–2066

    Article  PubMed  CAS  Google Scholar 

  19. Feingold D, Steele SR, Lee S, Kaiser A, Boushey R, Buie WD, Rafferty JF (2014) Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum 57(3):284–294

    Article  PubMed  Google Scholar 

  20. Janes S, Meagher A, Frizelle F (2005) Elective surgery after acute diverticulitis. Br J Surg 92(2):133–142

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    Emre Gorgun, Ozgen Isik, Ipek Sapci, Erman Aytac, Maher A. Abbas, Gokhan Ozuner, James Church & Scott R. Steele

Authors
  1. Emre Gorgun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ozgen Isik
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ipek Sapci
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Erman Aytac
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maher A. Abbas
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gokhan Ozuner
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. James Church
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Scott R. Steele
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emre Gorgun.

Ethics declarations

Disclosures

Drs. Emre Gorgun, Ozgen Isik, Ipek Sapci, Erman Aytac, Maher A. Abbas, Gokhan Ozuner, James Church, and Scott R. Steele have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gorgun, E., Isik, O., Sapci, I. et al. Colonoscopy-induced acute diverticulitis: myth or reality?. Surg Endosc 32, 3290–3294 (2018). https://doi.org/10.1007/s00464-018-6049-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-6049-8

Keywords

Search

Navigation