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Objective: Current recommended diagnostic methods for diverticulitis include computed tomography (CT) and follow-up colonoscopy to exclude a cancer diagnosis. This study aimed to determine the prevalence of occult colon cancer in diverticulitis patients due to similar CT findings.
Methods: This was a retrospective analysis of patients diagnosed with acute diverticulitis by CT at Vajira Hospital between 2012 and 2017. Data on sex, age, BMI, laboratory parameters, smoking status, alcohol consumption, clinical presentation, and modified Hinchey classification were collected. Risk factors for the discovery of colon cancer after an acute diverticulitis diagnosis by CT were identified by chi-squared test.
Results: We included all 91 patients diagnosed with diverticulitis by CT scan and reported by a radiologist. Five patients were excluded because they had not undergone colonoscopy after their diverticulitis subsided. The mean age was 69.1 years (range, 35–96 years), and 54.7% were male. The main presenting symptom was abdominal pain (69.8%). Diverticulitis occurred most frequently in the sigmoid colon (52.3%). Colon cancer was observed in eight diverticulitis patients (9.3%). The factors associated with colon cancer occurrence were the location of the disease in the sigmoid colon (P = 0.038), clinical presentation of abdominal pain (P = 0.002), and Hinchey II score (P < 0.001).
Conclusion: Occult colon cancer could be found in diverticulitis patients because of some mimicking imaging features in 9.3% of patients, and therefore, all patients diagnosed with diverticulitis should undergo colonoscopy after their disease has subsided, especially those at least 65 years of age, those with sigmoid diverticulitis, and those with Hinchey classification II, as they are at a higher risk for colon cancer.
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