Risk of colorectal cancer following CT-verified acute diverticulitis -a nationwide population-based cohort study

AIM: Routine colonoscopy to exclude colorectal cancer (CRC) after CT-verified acute diverticulitis is controversial. This study aimed to compare the incidence of CRC in acute diverticulitis patients with that in the general population. METHOD: Patients with an emergency admission for diverticular disease, to any Norwegian hospital, between January 1st , 2008 and December 31st , 2010 were included through identification in the Norwegian Patient Registry using International Classification of Diseases (ICD-10) codes K57.1-9. To estimate the age-specific distribution of CT-verified acute uncomplicated diverticulitis (AUD) and acute complicated diverticulitis (ACD) in this nationwide study population, numbers from the largest Norwegian emergency hospital were used. Patients diagnosed with CRC within one year following the admission for acute diverticulitis were detected through cross-matching with the Cancer Registry of Norway. Based on both Norwegian age-specific incidence of CRC and estimated age-specific distribution of CT-verified diverticulitis, standard morbidity ratios (SMR) were calculated.RESULTS: A total of 7473 patients with emergency admissions for diverticular disease were identified (estimated CT-verified AUD n=3523, ACD n=1206), and of these 155 patients were diagnosed with CRC within one year. Eighty had a CT-verified diverticulitis at index admission (41 AUD; 51.3% and 39 ACD; 49.7%). Compared to the general population SMR was 6.6 following CT-verified AUD and 16.3 following ACD respectively.CONCLUSION: The risk of CRC is higher than in the general population, the first year after CT-verified acute diverticulitis, especially after ACD. This likely represents misdiagnosis of CRC as acute diverticulitis. Follow-up colonoscopy should be recommended to all patients admitted with acute diverticulitis

Reaching adulthood with Hirschsprung's disease : Patient experiences and recommendations for transitional care

Background/Purpose: The need for transitional care has gained increased focus in the treatment of patients with congenital colorectal disorders. We aimed to acquire in-depth knowledge about the experiences of adult patients with Hirschsprung's disease (HD) and their suggestions for transitional care. Methods: Binational study applying gender equal focus group interviews (FGI). Results: Seventeen (9 men) of 52 invited patients with median age 29 (19–43) years participated. Three themes evolved from the FGI. “Scarred body and soul” describes the somatic and psychosocial challenges the patients experienced and “limited health literacy on HD” refers to the patients' lack of HD knowledge. “Absent transition” depicts missing transitional care and the patients' inability to find adult HD specialists. The adult HD patients strongly recommended transitional care from early teens with focus on information about HD and establishment of a peer-to-peer program. They also emphasized the possibility of being referred to a pelvic floor center. Conclusions: HD negatively influences patients' somatic and psychosocial health in childhood, adolescence and adulthood. Adult HD patients strongly recommend transitional care from early teens and the possibility for referral to a center working with pelvic floor dysfunctions. Level of evidence: IV Type of research: Clinica