Colonoscopy after Hinchey I and II left-sided diverticulitis: utility or futility?
BACKGROUND
Modern 64- to 128-slice computed tomography (CT) scanners have questioned the need for routine colonoscopy after hospital admission for presumed uncomplicated diverticulitis.


METHODS
This is a retrospective review of all patients (>18 years) who underwent planned colonoscopy after admission for Hinchey I or II acute diverticulitis (January 2009 to January 2014). The findings on the final radiologist report were then correlated with the colonoscopy results.


RESULTS
In total, 110 patients (mean age, 55.2 ± 16; 46.4% female) underwent a subsequent colonoscopy (median, 60 days) after admission for diverticulitis. Overall, 102 patients (92.7%) had CT findings consistent with definitive diverticulitis, 6 patients had a diagnosis suggestive of diverticulitis on CT scan, and 2 patients had masses on their admission CT scans. Within the group with definitive diverticulitis, follow-up colonoscopy identified diverticulosis in 99 (97.0%), whereas the other 3 had normal findings. Of the patients with CT scans suggestive of diverticulitis, follow-up colonoscopy showed 3 with diverticulosis, 2 with malignancies, and 1 with nonspecific inflammation. The reliability of CT scans for diverticulitis compared with colonoscopy was found to have a kappa = .829 (P < .001; 95% confidence interval, .629, 1.21).


CONCLUSIONS
Follow-up colonoscopy should be performed when a CT scan suggests malignancy, nonspecific inflammatory findings, or the patient is otherwise due for routine screening or surveillance. In this study, there was no benefit of follow-up colonoscopy in patients with CT-confirmed diverticulitis in the absence of other concerning or indeterminate findings.
Department of Surgery, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431, USA. Electronic address: averyw21@gmail.com.
Avery S
AS
Walker
Department of Surgery, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431, USA.
Jason R
JR
Bingham
Department of Surgery, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431, USA.
Karmon M
KM
Janssen
Department of Surgery, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431, USA.
Eric K
EK
Johnson
Department of Colon and Rectal Surgery, UMass Memorial Medical Center, Worcester, MA, USA.
Justin A
JA
Maykel
Department of Surgery, FEU NRMF Medical Center, West Fairview, Quezon City, Philippines.
Omar
O
Ocampo
Department of Surgery, Visayas Community Medical Center, Cebu City, Central Visayas, Philippines.
John P
JP
Gonzalez
Department of Surgery, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431, USA.
Scott R
SR
Steele
D000208:Acute Disease; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods*; D004239:Diverticulitis, Colonic / Q000175:diagnosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed / Q000379:methods*; D019564:Unnecessary Procedures
Colonoscopy; Diverticulitis; Inflammatory bowel disease; Malignancy