Post-colonoscopy diverticulitis: A systematic review

Abstract

BACKGROUND Post-colonoscopy diverticulitis is increasingly recognized as a potential complication. However, the evidence is sparse in the literature. AIM To systematically review all available evidence to describe the incidence, clinical course with management and propose a definition. METHODS The databases PubMed, EMBASE and Cochrane databases were searched using with the keywords up to June 2020. Additional manual search was performed and cross-checked for additional references. Data collected included demographics, reason for colonoscopy, time to diagnosis, method of diagnosis (clinical vs imaging) and management outcomes. RESULTS A total of nine studies were included in the final systematic review with a total of 339 cases. The time to diagnosis post-colonoscopy ranged from 2 h to 30 d. Clinical presentation for these patients were non-specific including abdominal pain, nausea/vomiting, per rectal bleeding and chills/fever. Majority of the cases were diagnosed based on computed tomography scan. The management for these patients were similar to the usual patients presenting with diverticulitis where most resolve with non-operative intervention ( i.e. , antibiotics and bowel rest). CONCLUSION The entity of post-colonoscopy diverticulitis remains contentious where there is a wide duration post-procedure included. Regardless of whether this is a true complication post-colonoscopy or a de novo event, early diagnosis is vital to guide appropriate treatment. Further prospective studies especially registries should include this as a complication to try to capture the true incidence.

Postcolonoscopy Diverticulitis

“…17 In addition, the increasing life expectancy across the globe means that more and more elderly patients undergo colonoscopy and diverticular disease is more common as age advances. 5 In summary, PCD is a rare postcolonoscopy complication but, as our case reports demonstrate, can occasionally be met in endoscopy practice and be confused with more common presentations such as perforation or postdiathermy syndrome.…”

“…3 In a systematic review of PCD literature, a prospective study, 4 retrospective cohort studies, and 4 case reports were included. 1,5,8,9,[11][12][13][14] It is worth mentioning that all the reported cases were published by US and Asia Pacific sites and none from UK practices. 5 Among the reviewed studies, the 4 case reports highlighted cases of PCD with atypical presentations, characterized by elevated inflammatory markers only.…”

“…In a systematic review of PCD literature, a prospective study, 4 retrospective cohort studies, and 4 case reports were included. 1,5,8,9,11-14 It is worth mentioning that all the reported cases were published by US and Asia Pacific sites and none from UK practices. 5…”

Postcolonoscopy Complications

“…13 The theories related to the cause of this complication are very similar to those listed for postcolonoscopy appendicitis, including barotrauma secondary to insufflation, inadvertent intubation of a diverticulum, and fecalith impaction. 13 Symptoms and the clinical presentation can mimic perforation and PPCS. The CT scan remains the imaging of choice for evaluation, classification, and guidance for further management.…”

“…13 There are some theories about the mechanism of this complication and whether this is truly an acute de novo episode, an exacerbation of subclinical inflammation, or an overlap with other entities such as PPCS. 13 The theories related to the cause of this complication are very similar to those listed for postcolonoscopy appendicitis, including barotrauma secondary to insufflation, inadvertent intubation of a diverticulum, and fecalith impaction. 13 Symptoms and the clinical presentation can mimic perforation and PPCS.…”