Colorectal cancer screening in patients with diverticular disease after an acute diverticulitis episode

In patients with complicated diverticulitis (ie diverticulitis with a positive blood culture result, perforation, peritonitis, sepsis or septic shock, or an abscess larger than 5 cm in diameter), the prevalence of colorectal cancer is approximately 10%. These patients should undergo colonoscopy 6 to 8 weeks after an episode of acute diverticulitisRottier, 2019Sharma, 2014.

In patients with uncomplicated diverticulitis (ie diverticulitis without perforation, peritonitis, sepsis or septic shock, or an abscess larger than 5 cm in diameter), the prevalence of colorectal cancer is much lower (approximately 0.5%)Rottier, 2019Sharma, 2014. After an episode of uncomplicated diverticulitis, a colonoscopy is not required unless the patient has:

• imaging abnormalities suggestive of malignancy (eg abscess, ‘shouldering’ [shelf-like appearance] at the edges of the inflammatory mass, obstruction, or mesenteric or retroperitoneal lymphadenopathy)Hall, 2020
• atypical symptoms (eg bleeding, narrowed stools)
• delayed recovery (eg symptoms that do not resolve after a few days)Hall, 2020.