Early Diagnostic Colonoscopy in Complicated Sigmoid Diverticulitis: Feasibility and risks – A Prospective Study

Marty Zdichavsky, MD1, Dietmar Stuker, MD1, Dorte Wichmann, MD1, Jessica Lange, MD1, Martin Goetz, MD2, Alfred Konigsrainer, MD1, Thomas Kratt, MD1. 1Department of General, Visceral and Transplant Surgery, University Hospital Tubingen, 2Department of Gastroenterology, Hepatology and Infectious Diseases

INTRODUCTION: Early colonoscopy in acute complicated sigmoid diverticulitis is usually avoided but might give essential information prior to early-elective surgery. The aim of this prospective clinical study is to evaluate feasibility and safety of early in-hospital colonoscopy in acute complicated sigmoid diverticulitis.

METHODS AND PROCEDURES: 65 colonoscopies in 62 patients were performed early in acute sigmoid diverticulitis. Patients with free perforations were excluded. All patients received initial CT scans and were designated for early-elective sigmoid resection. Indications for colonoscopy were no colonic examination in the past year to exclude malignancies and chronic inflammatory bowl diseases. Patients’ data, white blood cells (WBC), C-reactive proteine (CRP), CT scans, endoscopic and histological findings, and complications were evaluated.

RESULTS: Of all 62 patients, grading of CT scans showed in 64.5% covered perforations of the sigmoid colon. Mean interval between acute attacks until colonoscopy was 6.0 days (range, 0-12 days), mean time for colonoscopy 20.5 min (range, 10-80 min). In 86% of cases colonoscopy was completed. In 26.2% of patients polypectomies were performed without complications with benign results histologically. In one patient with a not passable sigmoid stenosis iatrogenic perforation occurred and in another one carcinoma was not detected visually, but revealed histologically.

CONCLUSIONS: Early colonoscopy after an attack of acute complicated sigmoid diverticulitis is safe and effective with a very low risk of complications. Caution should be taken in patients with high-grade post-inflammatory stenosis. Prior to early-elective surgery for sigmoid resection significant pathologies can be detected that might interfere with the surgical strategy.

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