Frequency of Occult Colon Cancer in Diverticulitis Patients at Vajira Hospital

Main Article Content

Pimchanok Auypornrungrat
Rangsima Thiengthiantham

Abstract

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.

Downloads

Download data is not yet available.

Article Details

Section
Original Articles

References

1. Sarma D, Longo WE. Diagnostic imaging for diverticulitis. J Clin Gastroenterol 2008;42(10):1139-41.

2. Stoker J, van Randen A, Laméris W, Boermeester MA. Imaging patients with acute abdominal pain. Radiology 2009;253(1):31-46.

3. Hall J, Hardiman K, Lee S, Lightner A, Stocchi L, Paquette IM, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis. Dis Colon Rectum 2020;63(6):728-47.

4. Ambrosetti P, Becker C, Terrier F. Colonic diverticulitis: impact of imaging on surgical management–a prospective study of 542 patients. Eur Radiol 2002;12(5):1145-9.

5. Lahat A, Yanai H, Sakhnini E, Menachem Y, Bar-Meir S. Role of colonoscopy in patients with persistent acute diverticulitis. World J Gastroenterol 2008;14(17):2763.

6. Sakhnini E, Lahat A, Melzer E, Apter S, Simon C, Natour M, et al. Early colonoscopy in patients with acute diverticulitis: results of a prospective pilot study. Endoscopy 2004;36(06):504-7.

7. Kaiser AM, Jiang J-K, Lake JP, Ault G, Artinyan A, Gonzalez-Ruiz C, et al. The management of complicated diverticulitis and the role of computed tomography. Am J Gastroenterol 2005;100(4):910-7.

8. Imaeda H, Hibi T. The burden of diverticular disease and its complications: West versus East. Inflamm Intest Dis 2018;3(2):61-8.

9. Nguyen GC, Sam J, Anand N. Epidemiological trends and geographic variation in hospital admissions for diverticulitis in the United States. World J Gastroenterol 2011;17(12):1600-5.

10. Rodkey GV, Welch CE. Changing patterns in the surgical treatment of diverticular disease. Ann Surg 1984;200(4):466–78.

11. Rosemar A, Angerås U, Rosengren A. Body mass index and diverticular disease: a 28-year follow-up study in men. Dis Colon Rectum 2008;51(4):450-5.

12. Manabe N, Haruma K, Nakajima A, Yamada M, Maruyama Y, Gushimiyagi M, et al. Characteristics of colonic diverticulitis and factors associated with complications: a Japanese multicenter, retrospective, cross-sectional study. Dis Colon Rectum 2015;58(12):1174-81.

13. Lim DR, Kuk JC, Shin EJ, Hur H, Min BS, Lee KY, et al. Clinical outcome for management of colonic diverticulitis: characteristics and surgical factor based on two institution data at South Korea. Int J Colorectal Dis 2020;35:1711-8.

14. Schneider EB, Singh A, Sung J, Hassid B, Selvarajah S, Fang SH, et al. Emergency department presentation, admission, and surgical intervention for colonic diverticulitis in the United States. Am J Surg 2015;210(2):404-7.

15. Díaz JJT, Asenjo BDA, Soriano MR, Fernández CJ, de Solórzano Aurusa JO, de Heredia Rentería JPB. Efficacy of colonoscopy after an episode of acute diverticulitis and risk of colorectal cancer. Ann Gastroenterol 2020;33(1):68–72.

16. Wong S-K, Ho Y-H, Leong AP, Seow-Choen F. Clinical behavior of complicated right-sided and left-sided diverticulosis. Dis Colon Rectum 1997;40(3):344-8.

17. Teo NZ, Wijaya RJSG. Right Sided Acute Uncomplicated Diverticulitis: A 10 Year Retrospective Review of an Asian Cohort. Surg Gastroenterol Oncol 2019;24(3):146-51.

18. Kim JH, Cheon JH, Park S, Kim BC, Lee SK, Kim TI, et al. Relationship between disease location and age, obesity, and complications in Korean patients with acute diverticulitis: a comparison of clinical patterns with those of Western populations. Hepatogastroenterology 2008;55(84):983-6.

19. Oh H-K, Han EC, Ha H-K, Choe EK, Moon SH, Ryoo S-B, et al. Surgical management of colonic diverticular disease: discrepancy between right-and left-sided diseases. World J Gastroenterol 2014;20(29):10115–20.

20. Manabe N, Haruma K, Nakajima A, Yamada M, Maruyama Y, Gushimiyagi M, et al. Characteristics of colonic diverticulitis and factors associated with complications: a Japanese multicenter, retrospective, cross-sectional study. Dis Colon Rectum 2015;58(12):1174-81.

21. Meyer J, Orci LA, Combescure C, Balaphas A, Morel P, Buchs NC, et al. Risk of colorectal cancer in patients with acute diverticulitis: a systematic review and meta-analysis of observational studies. Clin Gastroenterol Hepatol 2019;17(8):1448-56.