A case report: Colonoscopy-induced perforated diverticulitis

Abstract

Introduction and importance: Colonoscopies are a common procedure performed today as an outpatient procedure. Currently, colonoscopy is the gold standard for diagnosis and surveillance of colon cancer. Colonoscopies are a safe procedure with a low complication risk; however, that risk varies based on if any interventions were performed, such as a polypectomy. A systematic review for the US Preventive Services Task Force noted that serious harm occurred in 2.8 per 1000 screening colonoscopies. Other studies have demonstrated a perforation rate of 0.5 per 1000 colonoscopies, post-colonoscopy bleeding rate of 2.6 per 1000 colonoscopies, and a mortality rate of 2.9 per 100,000 colonoscopies. A recent systematic review also noted post-colonoscopy diverticulitis as a potential complication, with time to diagnosis ranging from 2 h to 30 days, necessitating early recognition to help guide appropriate treatment. In this case report, we describe a patient who developed post-colonoscopy diverticulitis who presented to the emergency room with perforated diverticulitis requiring emergency sigmoid colectomy with end colostomy. Case presentation: A 63-year-old male who presented as an outpatient to the surgery clinic in need of a screening colonoscopy for a history of polyps and family history of colon cancer. He underwent an outpatient colonoscopy, which demonstrated sigmoid and ascending diverticula with no polyps or acute inflammation. One week later, he presented to the emergency room with left lower quadrant pain. He was subsequently diagnosed with perforated diverticulitis and was taken to the operating room for a sigmoid colectomy with an end colostomy. Clinical discussion: Although serious complications after a colonoscopy are rare, they do occur, and therefore, patients should be counseled preoperatively regarding the potential risks of the procedure. It is unclear what factors contributed to the patient's post-colonoscopy diverticulitis. He denied any previous abdominal surgeries or previous episodes of diverticulitis. He did have a history of colon polyps, but this colonoscopy did not include a polypectomy or any interventions. He also was taking daily prednisone, which may have increased his risk for an emergency procedure when presenting with diverticulitis. Given the limited data describing post-colonoscopy diverticulitis, further studies are needed to better characterize patients at risk and to decrease the occurrence. Conclusion: This case highlights the importance of a thorough discussion of potential complications before any procedure, even if the overall risks are low. In the emergency room, obtaining a detailed patient history, physical exam, laboratory work, and proper imaging lead to a proper diagnosis of post-colonoscopy diverticulitis despite the rare presentation.