Elmi et al evaluated 402 patients with acute diverticulitis diagnosed on a contrast enhanced CT with subsequent colonoscopy. Retrospectively, they looked at the complications of diverticulitis as markers for underlying carcinoma. The presence of mesenteric or retroperitoneal lymph nodes and bowel obstruction were the highest risk factors for underlying colonic carcinoma (odds ratio of 23 and 24 respectively). The presence of an abscess is also slightly associated with underlying carcinoma (odds ratio of 4). Prior studies demonstrated that the presence of fisutulous tracts and perforation were also markers for underlying carcinoma (see link below). This was not demonstrated on this study.
The incidence of carcinoma in this study was low at 9 cancers in the 402 patients included. 8 of the 9 cancers were diagnosed within 6 months of the initial presentation.
19% of the 402 patients had underlying colonic polyps. The presence of "obvious" subjective enhancement was highly associated with underlying polyps or carcinoma.
Population: mean age of 63.3 (range 50-94)
Intervention: Colonoscopy post diagnosis of acute diverticulitis (retrospective analysis)
Comparison: the presence of complications associated with acute diverticulitis (obstruction, lymph nodes, and associated lymph nodes)
Outcome: The presence of bowel obstruction and enlarged lymph nodes is highly associated with underlying carcinoma in patients with diverticulitis.
Links: Pubmed, Original article
Related literature: Is colonoscopy still mandatory after a CT diagnosis of left-sided diverticulitis: can colorectal cancer be confidently excluded?
Elmi et al (2013). American Journal of Radiology. 200: 1269-1274
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