Advertisement

International Journal of Colorectal Disease

, Volume 33, Issue 7, pp 991–994 | Cite as

Prevalence of colorectal cancer in acute uncomplicated diverticulitis and the role of the interval colonoscopy

  • Soh Nicholas Yock Teck 
  • Chia Daryl Kai Ann 
  • Teo Nan Zun 
  • Ong Calvin Jian Ming 
  • Ramesh Wijaya
Short Communication
  • 258 Downloads

Abstract

Purpose

Although computed tomography (CT) is the imaging modality of choice for diagnosing colonic diverticulitis today, there remains a risk of colorectal cancer mimicking diverticulitis due to overlapping imaging features. Current practice guidelines recommend interval colonoscopy after diverticulitis to exclude occult malignancy. Some authors have suggested that this may be unnecessary in patients with uncomplicated diverticulitis. The aim of our study was to examine the prevalence of occult colorectal cancer in patients with CT-proven acute uncomplicated diverticulitis in an Asian population.

Methods

This was a retrospective study of all patients admitted for CT-proven acute uncomplicated diverticulitis between 2007 and 2011 in a single institution. Colonoscopy and histopathology reports were reviewed for patients who underwent interval colonic evaluation. For patients who defaulted follow-up, national health records were reviewed for any subsequent diagnoses of colorectal cancer. The primary outcome was prevalence of colorectal cancer in the cohort. Secondary outcome was prevalence of advanced adenomas.

Results

A total of 227 patients with acute uncomplicated diverticulitis were included in our study. One hundred and thirty-five patients (59.5%) underwent follow-up colonic evaluation. The overall prevalence of colorectal cancer was 1.8%, with half these patients presenting with acute colonic obstruction after defaulting follow-up evaluation. Of the patients, 1.5% who underwent colonoscopy had advanced adenomas.

Conclusion

Prevalence of colorectal cancer in patients with CT-proven acute uncomplicated diverticulitis may not be as low as previously suggested. We recommend that patients with acute uncomplicated diverticulitis continue to be offered interval colonoscopy until larger studies demonstrate the safety of omission.

Keywords

Asian population Colorectal cancer Acute uncomplicated diverticulitis 

References

  1. 1.
    DeStigter KK, Keating DP (2009) Imaging update: acute colonic diverticulitis. Clin Colon Rectal Surg 22(03):147–155CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Werner A, Diehl SJ, Farag-Soliman M, Düber C (2003) Multi-slice spiral CT in routine diagnosis of suspected acute left-sided colonic diverticulitis: a prospective study of 120 patients. Eur Radiol 13(12):2596–2603CrossRefPubMedGoogle Scholar
  3. 3.
    Horton KM, Corl FM, Fishman EK (2000) CT evaluation of the colon: inflammatory disease 1. Radiographics 20(2):399–418CrossRefPubMedGoogle Scholar
  4. 4.
    Stollman N, Raskin JB (2004) Diverticular disease of the colon. Lancet 363(9409):631–639CrossRefPubMedGoogle Scholar
  5. 5.
    Lau KC, Spilsbury K, Farooque Y, Kariyawasam SB, Owen RG, Wallace MH, Makin GB (2011) Is colonoscopy still mandatory after a CT diagnosis of left-sided diverticulitis: can colorectal cancer be confidently excluded? Dis Colon Rectum 54(10):1265–1270CrossRefPubMedGoogle Scholar
  6. 6.
    Kim JH, Cheon JH, Park S, Kim BC, Lee SK, Il KT et al (2008) Relationship between disease location and age, obesity, and complications in Korean patients with acute diverticulitis: a comparison of clinical patterns with those of Western populations. Hepato-Gastroenterology 55(84):983–986PubMedGoogle Scholar
  7. 7.
    Fong SS, Tan EY, Foo A, Sim R, Cheong DM (2011) The changing trend of diverticular disease in a developing nation. Colorectal Dis 13(3):312–316CrossRefPubMedGoogle Scholar
  8. 8.
    Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Harford WV, Provenzale D, Sontag S, Schnell T, Durbin TE, Nelson DB (2000) Use of colonoscopy to screen asymptomatic adults for colorectal cancer. N Engl J Med 343(3):162–168CrossRefPubMedGoogle Scholar
  9. 9.
    Regula J, Rupinski M, Kraszewska E, Polkowski M, Pachlewski J, Orlowska J, Nowacki MP, Butruk E (2006) Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med 355(18):1863–1872CrossRefPubMedGoogle Scholar
  10. 10.
    Suhardja TS, Norhadi S, Seah EZ, Rodgers-Wilson S (2017) Is early colonoscopy after CT-diagnosed diverticulitis still necessary? Int J Color Dis 32(4):485–489CrossRefGoogle Scholar
  11. 11.
    Horesh N, Saeed Y, Horesh H, Berger Y, Speter C, Pery R, Rosin D, Gutman M, Zmora O (2016) Colonoscopy after the first episode of acute diverticulitis: challenging management paradigms. Tech Coloproctol 20(6):383–387Google Scholar
  12. 12.
    Lam TJ, Meurs-Szojda MM, Gundlach L, Belien JA, Meijer GA, Mulder CJ, Felt-Bersma RJ (2010) There is no increased risk for colorectal cancer and adenomas in patients with diverticulitis: a retrospective longitudinal study. Colorectal Dis 12(11):1122–1126CrossRefPubMedGoogle Scholar
  13. 13.
    Chan DK, Tan KK (2017) There is no role for colonoscopy after diverticulitis among asian patients less than 50 years of age. Gastrointestinal Tumors 3(3-4):136–140Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018
corrected publication May/2018

Authors and Affiliations

  • Soh Nicholas Yock Teck 
    • 1
  • Chia Daryl Kai Ann 
    • 2
  • Teo Nan Zun 
    • 3
  • Ong Calvin Jian Ming 
    • 3
  • Ramesh Wijaya
    • 3
  1. 1.Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
  2. 2.Ministry of Health HoldingsSingaporeSingapore
  3. 3.Department of General SurgeryChangi General HospitalSingaporeRepublic of Singapore

Personalised recommendations