Is the risk of colorectal cancer increased after a diverticulitis attack? Is routine colonoscopy necessary? our clinical experience

Abstract

Diverticular disease is common, particularly in Western societies and in older age groups. Diverticulitis, occurring in 10–25% of cases, is the most frequent complication of this condition. Computed tomography (CT) is the standard imaging modality for diagnosing diverticulitis. Previous studies have demonstrated an increased incidence of colorectal cancer (CRC) in colonoscopies performed after episodes of diverticulitis and its complications. This study aims to evaluate the necessity of colonoscopic assessment in differentiating colorectal cancers in patients diagnosed with diverticulitis and its complications via abdominal CT. Between January 2018 and December 2024, 290 cases diagnosed with diverticular disease and its complications were retrospectively analyzed in the General Surgery Department of Recep Tayyip Erdoğan University Training and Research Hospital. Twenty-one patients were excluded from the study due to mortality following perforation or lack of follow-up. Demographic and clinical data were obtained from hospital records. Among the 269 patients included in the study, malignancy was detected in 37 (13.8%) cases after elective colonoscopy. The mean age of patients diagnosed with colorectal malignancy was 70.3 ± 9.7 years, which was statistically significantly higher compared to patients without malignancy. CT evaluations of wall thickening at the diverticulitis site revealed malignancy in 22 of 105 patients (21%) with localized wall thickening. Additionally, tumors were identified in 12 of 13 patients (92.3%) with wall thickening in colonic segments outside the site of diverticular disease. The risk of malignancy in patients with diverticulitis increases with age. Many studies have recognized an increased incidence of colorectal cancer following diverticulitis episodes. Based on our findings, we recommend performing elective colonoscopy 6–8 weeks after the treatment process in patients presenting with diverticulitis due to the high prevalence of colorectal malignancies. While CT is considered the standard method for diagnosing diverticulitis, its limitations in detecting colorectal cancer should be acknowledged.