Surgical Endoscopy (2018) 32:3290–3294
Colonoscopy-induced acute diverticulitis: myth or reality?
· Ozgen Isik
· Ipek Sapci
· Erman Aytac
· Maher A. Abbas
· Gokhan Ozuner
· James Church
Scott R. Steele
Received: 29 June 2017 / Accepted: 11 January 2018 / Published online: 17 January 2018
© Springer Science+Business Media, LLC, part of Springer Nature 2018
Background Colonoscopy in patients with diverticulosis can be technically challenging and limited data exist relating to
the risk of post-colonoscopy diverticulitis. Our aim was to evaluate the incidence, management, and outcomes of acute
diverticulitis following colonoscopy.
Methods Study design is retrospective cohort study. Data were gathered by conducting an automated search of the electronic
patient database using current procedural terminology and ICD-9 codes. Patients who underwent a colonoscopy from 2003 to
2012 were reviewed to ﬁnd patients who developed acute diverticulitis within 30 days after colonoscopy. Patient demograph-
ics and colonoscopy-related outcomes were documented, which include interval between colonoscopy and diverticulitis,
colonoscopy indication, simultaneous colonoscopic interventions, and follow-up after colonoscopy.
Results From 236,377 colonoscopies performed during the study period, 68 patients (mean age 56 years) developed post-
colonoscopy diverticulitis (0.029%; 2.9 per 10,000 colonoscopies). Incomplete colonoscopies were more frequent among
patients with a history of previous diverticulitis [n = 10 (29%) vs. n = 3 (9%), p = 0.03]. Mean time to develop diverticuli-
tis after colonoscopy was 12 ± 8 days, and 30 (44%) patients required hospitalization. 34 (50%) patients had a history of
diverticulitis prior to colonoscopy. Among those patients, 14 underwent colonoscopy with an indication of surveillance
for previous disease. When colonoscopy was performed within 6 weeks of a diverticulitis attack, surgical intervention was
required more often when compared with colonoscopies performed after 6 weeks of an acute attack [n = 6 (100%) vs. n = 10
(36%), p = 0.006]. 6 (9%) out of 68 patients received emergency surgical treatment. 15 (24%) out of 62 patients who had
non-surgical treatment initially underwent an elective sigmoidectomy at a later date. Recurrent diverticulitis developed in
16 (23%) patients after post-colonoscopy diverticulitis.
Conclusions Post-colonoscopy diverticulitis is a rare, but potentially serious complication. Although a rare entity, possibility
of this complication should be kept in mind in patients presenting with symptoms after colonoscopy.
Keywords Colonoscopy · Diverticulitis · Colonoscopy complication
Colonoscopy is both a diagnostic and therapeutic tool that
is commonly used in screening and surveillance of colorec-
tal neoplasia . Several complications have been associ-
ated with colonoscopy including bleeding, perforation, and
pain. Fortunately, the rate of signiﬁcant complications is low
[2–8]. Other rare complications of colonoscopy may include
splenic laceration and bowel obstruction [2–4]. However,
these rates increase if a biopsy or polypectomy is performed
during colonoscopy [2–4, 9, 10].
There are several studies focused on either overall com-
plications of screening colonoscopy or colonoscopy per-
formed in the context of a patient with a recent history of
acute diverticulitis [2–4, 10]. However, data about acute
diverticulitis developing after a colonoscopy are limited.
We hypothesized that, while rare, the de novo development
of acute diverticulitis following colonoscopy may result in
signiﬁcant outcomes. Our aim was to evaluate the incidence,
management, and outcomes of acute diverticulitis develop-
ing after colonoscopy.
and Other Interventional Techniques
Presented at American Society of Colon and Rectal Surgeons
Annual Meeting, May 17th–21st 2014 Hollywood, FL.
* Emre Gorgun
Department of Colorectal Surgery, Digestive Disease
and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave,
Cleveland, OH 44195, USA