There is a long-standing belief that patients with a presumptive diagnosis of diverticulitis may instead be harboring colon cancer, but what is the real risk? In an analysis of a large database, patients whose diverticulitis is considered complicated—with abscess or perforation—had nearly a fourfold increased likelihood of having cancer or an advanced adenoma found on colonoscopy compared with the average-risk screening population. However, those with less severe diverticulitis had a decreased likelihood.
“Colon cancer can be misdiagnosed as diverticulitis, and for this reason colonoscopy is often recommended to exclude a missed cancer after patients recover from an episode of diverticulitis. However, this is a controversial recommendation that is based on limited evidence,” said investigator Walker D. Redd, MD, presenting the findings at the 2023 annual meeting of the American College of Gastroenterology (plenary 11). “Therefore, we felt that reliable estimates are needed to better understand whether this risk for colon cancer for the patient with diverticulitis is similar to or increased as compared to that of a screening population,” added Dr. Redd, a gastroenterology fellow at the University of North Carolina School of Medicine, in Chapel Hill.