Brief Article
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World J Surg Proced. Jul 28, 2013; 3(2): 13-17
Published online Jul 28, 2013. doi: 10.5412/wjsp.v3.i2.13
Screening for colorectal neoplastic lesions following acute diverticulitis: Would a sigmoidoscopy suffice?
Leong Ung Tiong, Ryan Jalleh, Edward J Travers, Thomas Paxton, Cecilia Innes-Wong, Savio G Barreto, Randall Williams
Leong Ung Tiong, Ryan Jalleh, Edward J Travers, Thomas Paxton, Cecilia Innes-Wong, Savio G Barreto, Randall Williams, Department of Surgery, Modbury Hospital, Modbury, SA 5092, Australia
Author contributions: Tiong LU contributed to design of study, acquisition of data, data analysis and interpretation, drafting of the manuscript; Jalleh R, Travers EJ, Paxton T and Innes-Wong C contributed to acquisition of data, drafting of the article; Barreto SG and Williams R contributed to conception and design of study, data interpretation, critical revision for important intellectual content; all authors read and approved the final manuscript.
Correspondence to: Savio G Barreto, MBBS, MS, PhD, Department of Surgery, Modbury Hospital, Smart Road, Modbury, SA 5092, Australia. georgebarreto@yahoo.com
Telephone: +61-8-81612267 Fax: +61-8-81612267
Received: January 8, 2013
Revised: May 29, 2013
Accepted: June 5, 2013
Published online: July 28, 2013
Processing time: 169 Days and 22.8 Hours
Abstract

AIM: To investigate the yield of colorectal malignant or premalignant lesions during colonoscopy performed following an episode of acute diverticulitis.

METHODS: A prospectively maintained electronic database of a public teaching hospital (Modbury Hospital, South Australia) was searched for international classification of diseases codes for acute diverticulitis from July 2007 to June 2011. The electronic database and each patient’s medical records were reviewed for demographic data, clinical presentation, investigation results, colonoscopy details and surgical intervention.

RESULTS: Two hundred and nineteen patients were diagnosed with acute diverticulitis with a median age of 60 years (range 24-93). One hundred and thirty-nine patients (63.5%) had follow-up screening colonoscopy, with the median interval between the episode of acute diverticulitis and colonoscopy being 8 wk (range: 1-66). Colonoscopy revealed polyps in 21 patients (15%) and no cases of colorectal cancer. Of the 21 patients with polyps, there were 14 patients (10%) with tubular/villous adenomas (13 in rectosigmoid region and 1 in descending colon).

CONCLUSION: Detection of colorectal cancer in patients undergoing routine colonoscopy following acute diverticulitis is rare. However, colonic polyps in the left colon are noted. A flexible sigmoidoscopy is an adequate screening tool in such patients. A complete colonoscopy reserved for patients with family history of colorectal cancer or with polyps detected on flexible sigmoidoscopy to evaluate the rest of the colon.

Keywords: Polyps; Surgery; Diverticulitis; Colonoscopy; Colorectal cancer

Core tip: This paper shows that of the 139 patients who underwent routine colonoscopy after an episode of acute diverticulitis, the incidence of adenomatous and malignant colonic polyps discovered were 10% and 0% respectively. These figures are similar to that in the general population. In addition all the polyps were discovered in the left colon, therefore a flexible sigmoidoscopy may be adequate for the purpose of excluding the presence of neoplastic lesions.