Early Colonoscopy in Patients with Acute Diverticulitis: Results of a Prospective Pilot Study

Background and Study Aims: Outcomes following early colonoscopy in patients with acute diverticulitis have not previously been studied. The present study describes the effects of early colonoscopy in patients with acute diverticulitis. Patients and Methods: Consecutive patients hospitalized for acute diverticulitis were included in the study. In the first phase, patients with adjacent peridiverticular air or fluid on computed tomography (CT) were excluded. In the second phase of the study, only patients with free intraperitoneal air were excluded. Results: The study population consisted of 107 patients. During the first phase of the study, 49 patients were included; 10 were excluded because of peridiverticular air or fluid. The remaining 39 patients underwent uneventful colonoscopy. During the second phase of the study, 58 patients were included; four were excluded because of free air in the peritoneum. The remaining 54 patients underwent colonoscopy, and perforation of the sigmoid colon occurred in one patient with peridiverticular air. Complete colonoscopy to the cecum or to the obstructing tumor was achieved in 76 patients (81.7 %). A second colonoscopy performed 6 weeks later in 16 of the remaining 17 patients was successfully completed. Findings during the first colonoscopy were polyps in nine cases, polyp with infiltrating adenocarcinoma in one, obstructing adenocarcinoma in one, and a bone trapped in a diverticulum in another one. The latter two patients had a more protracted course and were clearly the ones who benefited most from the colonoscopy. Conclusions: Early colonoscopy in patients with acute diverticulitis may alter the working diagnosis and be of therapeutic value. The rate of cecal intubation is lower and the perforation rate appears to be higher. A clear-cut indication therefore has to be evident clinically.

References

• 1 Cho K C, Morehouse H T, Alterman D D, Thornhill B A. Sigmoid diverticulitis: diagnostic role of CT - comparison with barium enema studies.  Radiology. 1990;  176 111-115
• 2 Rao P M. CT of diverticulitis and alternative conditions.  Semin Ultrasound CT MR. 1999;  20 86-93
• 3 Hulnick D H, Megibow A J, Balthazar E J. et al . Computed tomography in the evaluation of diverticulitis.  Radiology. 1984;  152 491-495
• 4 Hachigian M P, Honickman S, Eisenstat T E. et al . Computed tomography in the initial management of acute left-sided diverticulitis.  Dis Colon Rectum. 1992;  35 1123-1129
• 5 Almy T P, Howell D A. Medical progress. diverticular disease of the colon.  N Engl J Med. 1980;  302 324-331
• 6 Penfold J C. Perforation of the colon complicating colonoscopy: report of a case.  Dis Colon Rectum. 1975;  18 626-627
• 7 Forde K A. Colonoscopy in complicated diverticular disease.  Gastrointest Endosc. 1977;  23 192-193
• 8 Dean A C, Newell J P. Colonoscopy in the differential diagnosis of carcinoma from diverticulitis of the sigmoid colon.  Br J Surg. 1973;  60 633-635
• 9 Panish J F. Limitations and complications of colonoscopy.  Gastrointest Endosc. 1980;  26 20S-21S
• 10 Waye J D, Bashkoff E. Total colonoscopy: is it always possible?.  Gastrointest Endosc. 1991;  37 152-154
• 11 Marshall J B, Barthel J S. The frequency of total colonoscopy and terminal ileal intubation in the 1990s.  Gastrointest Endosc. 1993;  39 518-520