Computed tomography diagnosed first time diverticulitis and colorectal cancer
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ORIGINAL ARTICLE
Computed tomography diagnosed first time diverticulitis and colorectal cancer Anna Fogelstrom 1 & Filip Hallen 1 & Klas Pekkari 1 Accepted: 13 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Computed tomography (CT) with intravenous contrast is the gold standard for diagnosing diverticulitis. Published results concerning follow-up colonoscopy after an episode of acute diverticulitis to rule out cancer are conflicting. This study aimed to evaluate the risk of underlying colonic malignancy in patients diagnosed with a first time diverticulitis with a state of the art CT investigation with intravenous contrast. Methods Retrospective analysis of all patients with a first episode of diverticulitis diagnosed with CT at Danderyds Hospital, Stockholm, between January 1, 2015, and November 16, 2016. Data on modified Hinchey classification, age, sex, laboratory parameters, body mass index, and colonoscopy findings were recorded. Results The study identified 518 patients with a CT-verified first time diverticulitis. Four hundred twenty-six (82%) of the 518 patients underwent follow-up colonoscopy and constitute our study cohort. CT showed that 402 patients had uncomplicated diverticulitis (modified Hinchey Ia), and 24 patients had complicated diverticulitis (modified Hinchey ≥Ib). Colonoscopy showed cancers in 2 (0.5%) of the 426 patients initially diagnosed as acute diverticulitis. In addition, 13 (3%) patients had advanced adenomas, and 121 (28%) patients had benign adenomas upon follow-up colonoscopy. Patients with CT-verified complicated diverticulitis (modified Hinchey ≥Ib) had a significantly higher risk for colon cancer compared with patients with an uncomplicated first time diverticulitis. Conclusion Our study supports routine follow-up colonoscopy after a first episode of CT-diagnosed complicated diverticulitis. In contrast, we do not find an increased risk for neoplasia in patients with uncomplicated diverticulitis. Keywords Diverticulitis . Colorectal cancer . Computed Tomography
Introduction Colonic diverticular disease is common in industrialized societies with a prevalence increasing with age, reaching 50 to 70% in patients 80 years or older [1]. The disease affects the sigmoid and descending colon in more than 90% of the patients. Approximately 10 to 25% of patients with diverticular disease develop one or several episodes of diverticulitis. The diverticulitis may be uncomplicated, with bowel wall thickening and/or adjacent intraabdominal fat stranding, or complicated, with the presence of bowel perforation with free intraabdominal air, abscess, or fistula [2]. The gold standard
* Klas Pekkari [email protected] 1
Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institute, S-182 88 Stockholm, Sweden
for diagnosis is computed tomography (CT) with intravenous contrast for which the sensitivity and specificity are approximately 90 to 95% and 97 to 99%, respectively [1, 3–7]. Whether diagnosis of acute diverticuli
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