TP9.2.9Luminal Investigation Following CT Diagnosed Acute Diverticulitis

The commissioning guide for colonic diverticular disease by the Royal Collage of Surgeons (2014) states that all patients should undergo luminal investigations once an acute attack of diverticulitis has passed. The rational behind this is to ensure a malignant polyp is not missed, however there is mounting evidence and opinion that this may not be necessary. We aim to evaluate how our unit follows the commissioning guide and investigate the number of subsequent polyps and cases of malignancy found. Surgical inpatients with a CT proven diagnosis of acute diverticulitis within a one year period (2018) were included. Their CT scans were reviewed to confirm the diagnosis and electronic records examined to see if luminal investigations were requested, occurred and what the findings were. There were 78 cases of CT confirmed diverticulitis. Of these 11 patients underwent emergency Hartmanns procedure. This left 67 patients in whom investigations were requested in 47. Within the 20 cases were follow up was not requested, 50% had a mitigating factor. 40/47 patients who had investigations booked underwent the requested test. In 6 cases a polyp was found and there were no cases of colorectal cancer. Based on current guidance there is scope to improve the follow up investigations in this population of patients with CT proven diverticulitis. As no colorectal cancers were found this is in keeping with the growing notion that colonoscopy may be reserved for those with complicated diverticulitis on CT or with CT findings on a background of ‘red flag’ symptoms.