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.
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S. Bar-Meir, M. D.
Dept. of Gastroenterology, Chaim Sheba Medical Center
Tel Hashomer 52621 · Israel ·
Fax: +972-3-5303070
Email: barmeir@netvision.net.il
