TU2.3 Flexible sigmoidoscopy after management of CT proven uncomplicated acute diverticulitis: a closed loop audit of local practice at tertiary care centre

Abstract

Background Routine practice of offering a flexible sigmoidoscopy after patients undergoing medical management of CT proven uncomplicated acute diverticulitis (UAD) has been revisited recently and is not required in the absence of red flag symptoms as per the recommendations of the World Society of Emergency Surgery (WSES). The aim of this audit project is to evaluate whether local practice in requesting flexible sigmoidoscopy after the medical management of UAD is in line with WSES guidelines. Methods The data of all patients undergoing medical management of CT proven UAD for 19 months (2019–2021) was collected and analysed as per guidelines provided by the WSES. Results The study cohort included the subjects treated both as in-patients as well as out-patients in the ambulatory care unit. Out of 115 admissions with acute diverticulitis during first loop of the audit, there were 80 (69.5%) patients diagnosed with CT proven UAD. Thirty-nine patients (48/8%) with UAD were booked to undergo flexible sigmoidoscopy and only 10 patients (25.64%) were diagnosed with sub-centimetre colonic polyps. Second loop included 49 patients, of which 34 patients were diagnosed with UAD and 10 (29.4%) patients underwent flexible sigmoidoscopy showing polyps in 3 (8.8%) patients. Conclusion This audit project successfully has shown reduced booking rate of flexible sigmoidoscopy following the medical management of UAD. Given the low rate of positive findings, the high rate of outpatient request for sigmoidoscopy in the uncomplicated group appeared unjustified.