# Assessing the Role of Follow-Up Investigations After Acute Diverticulitis in Detecting Colorectal Cancer

## TL;DR

This study examines how often patients with acute diverticulitis followed up with investigations and how many were later diagnosed with colorectal cancer.

## Contribution

The study evaluates adherence to follow-up guidelines and identifies CRC cases following acute diverticulitis in a specific hospital setting.

## Key findings

- Only 50.9% of patients with acute diverticulitis underwent follow-up investigations within one year.
- 2% of patients diagnosed with diverticulitis were later found to have colorectal cancer.
- Most CRC cases were in patients with complicated diverticulitis, such as perforation or abscess formation.

## Abstract

Background

Diverticula are small, sac-like protrusions that form along the gastrointestinal tract, most often in the sigmoid colon. While some individuals with diverticula remain asymptomatic, some patients experience symptoms, and a minority of patients go on to develop acute diverticulitis. The latter occurs when a fecalith becomes trapped within a diverticulum, leading to colonic wall damage, swelling, bacterial growth, and inflammation. A computed tomography (CT) scan is considered the gold standard imaging technique for diagnosing acute diverticulitis. However, the imaging characteristics of diverticulitis can closely resemble those of colorectal cancer (CRC), potentially obscuring a cancer diagnosis.

Aim

This audit aims to assess whether patients admitted to Mater Dei Hospital, Malta, who were diagnosed with acute diverticulitis in 2021 and 2022, adhered to the recommendations outlined in the guidelines. Furthermore, the audit will investigate the percentage of these patients who were subsequently diagnosed with CRC following a radiologically confirmed episode of acute diverticulitis.

Method

All patients with CT-confirmed diverticulitis at Mater Dei Hospital from January 2021 to December 2022 were included in this audit. Data on follow-up investigations-via imaging or endoscopy within one year of hospital presentation-were gathered from radiology reports and endoscopy records. Results were compiled and analysed using Microsoft Excel® (Microsoft Corp., Redmond, WA, US).

Results

From January 2021 to December 2022, 395 patients were diagnosed with acute diverticulitis at Mater Dei Hospital, comprising 222 (56.2%) men and 173 (43.8%) women, with a mean age of 60 years. Follow-up investigations within one year were conducted in 201 (50.9%) patients. Among these, eight patients (2%) comprising five women and three men, with a mean age of 67 years, were diagnosed with CRC during follow-up. Of these, two had initially been diagnosed with uncomplicated diverticulitis, while six presented with complicated diverticulitis, characterised by perforation or abscess formation on their initial CT scans.

Conclusion

Guideline-recommended follow-up within one year of diagnosis was completed in only about half of the patients, with approximately eight (2%) patients subsequently diagnosed with CRC. It is worth noting that some patients may have undergone investigations beyond the one-year mark. Routine follow-up imaging and colonoscopy may not be necessary in every case; rather, targeted follow-up may be more appropriate for patients with complicated cases or ambiguous findings on the initial imaging.