Colonic Investigation following Diverticulitis at Northland District Health Board

Authors List

Tiro, J., Dept of General Surgery, Whangarei Hospital, New Zealand Lengyel, O., Dept of General Surgery, Whangarei Hospital, New Zealand McGuinness, M., Dept of General Surgery, Whangarei Hospital, New Zealand Varghese, C., Dept of General Surgery, Whangarei Hospital, New Zealand Harmston, C., Dept of General Surgery, Whangarei Hospital, New Zealand

Introduction: Diverticulitis is a common General Surgical condition seen across the Western World.
The risk of malignancy in those with uncomplicated diverticulitis is estimated to be 0.7%, compared with up to 10% in those with complicated diverticulitis. European Society of Coloproctology guidelines recommend Colonic Assessment in patients with Complicated Diverticulitis only.

Aims: To investigate which patients in Northland undergo Colonic Assessment (Colonoscopy or CT Colonography) following an episode of Diverticulitis, and to establish our level of adherence to Evidence Based Guidelines.

Methods: A retrospective review of all adults aged >18 who were admitted to Whangarei hospital with diverticulitis between 1 January 2015 and 31 December 2019.
Patients were classified as complicated or uncomplicated based in the complexity of their diverticulitis as reported by a consultant radiologist. Patient with resection on index admission or who had colonoscopy in the preceding three years were excluded.

Results: 379 patients formed the primary cohort; 97 (26%) with complicated disease and 282 (74%) with uncomplicated disease. 183 (48%) patients underwent colonic investigation following an admission with diverticulitis; 51 (53%) in the complicated group and 132 (47%) in the uncomplicated group. Colonoscopy (170 procedures) was more commonly performed compared to CT Colonography (18), with 5 patients having both.

2 patients (0.5%) were found to have a colonic malignancy on colonoscopy, both in the uncomplicated group. Additionally the rate of polpy detection was 12.9%; 49 benign polyps were found, 8 (8.2%) in the complicated group and 41 (14.5%) in the uncomplicated group.

Conclusions: Colonic investigation in Northland following inpatient admission with diverticulitis is not in keeping with international guidelines. Detection of significant disease in uncomplicated patients highlights the complexity decision making concerning colonic investigation in this group of patients. Larger studies are needed to help formulate NZ specific guidelines.

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