Clinical Review  |   December 2015
Utility of Colonoscopy to Exclude Underlying Malignant Polyps After Resolution of Uncomplicated Diverticulitis
Author Notes
  • From the Division of Community Internal Medicine (Dr Disbrow), the Division of Gastroenterology and Hepatology (Dr Foxx-Orenstein), and the Division of Hospital Internal Medicine (Dr Agrwal) at the Mayo Clinic in Scottsdale, Arizona. 
  •  *Address correspondence to Molly Disbrow, MD, Division of Community Internal Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259-5499. E-mail: disbrow.molly@mayo.edu
     
Article Information
Gastroenterology
Clinical Review   |   December 2015
Utility of Colonoscopy to Exclude Underlying Malignant Polyps After Resolution of Uncomplicated Diverticulitis
The Journal of the American Osteopathic Association, December 2015, Vol. 115, 720-723. doi:10.7556/jaoa.2015.147
The Journal of the American Osteopathic Association, December 2015, Vol. 115, 720-723. doi:10.7556/jaoa.2015.147
Diverticulitis is a common disorder particularly in Western countries.1 Despite the evidence that exists regarding assessment and management of acute diverticulitis, practice patterns often rely on decades-old anecdotal literature. In this review, we discuss the routine practice of performing a colonoscopy to exclude malignant polyps after an episode of acute diverticulitis. 
According to the Centers for Disease Control and Prevention National Hospital Discharge Survey, diverticulitis accounts for 814,000 hospitalizations in the United States annually.2 Diverticula result from weakened muscle layers in the colonic wall at points where blood vessels traverse from the serosa to deeper layers and can also be caused by diets low in fiber and intestinal motility factors (eg, constipation). Diverticulitis occurs when a micro- or macroperforation develops in a diverticulum as a result of increased intraluminal pressure due to fecal matter obstruction at the diverticulum neck. In three-quarters of patients, the inflammation stays local and is contained by pericolic fat and mesentery, whereas the remaining one-fourth may go on to develop complications, such as abscess, perforation, fistula, or obstruction. The diagnosis of complicated vs uncomplicated diverticulitis, based historically on clinical severity, now depends on the results of radiologic examinations, including ultrasonography and computed tomography (CT), along with symptoms of severity. Patients with uncomplicated diverticulitis are generally able to tolerate some oral intake, including oral antibiotics to manage gram-negative and anaerobic organisms. Complicated diverticulitis is defined by diagnostic evidence of abscess, fistula, obstruction, or perforation. 
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