S4616 Diverticulitis Derived from Diagnostic Colonoscopy

Introduction: Post-colonoscopy diverticulitis is a known, however, rare entity in the world of endoscopy. One systemic review encompassing 3 large databases spanning over 3 decades acknowledges an incidence of 0.11%-0.37%. Although uncommon, the potential of post-colonoscopy diverticulitis should be a discussed potential complication when educating patients on risks and benefits of colonoscopic evaluation. Case Description/Methods: A 74-year-old woman was initially evaluated outpatient for chronic abdominal pain and intermittent diarrhea. Laboratory evaluation was largely unremarkable with negative Cryptosporidium/Giardia, Clostridioides difficile, Celiac Serology, Tissue Transglutaminase, Total IgA, fecal calprotectin, fecal elastase, and thyroid stimulating hormone/Total T4. Work up was continued with diagnostic colonoscopy performed on 1/16/25. The procedure itself was technically difficult as colonoscope was unable to traverse the sigmoid colon due to angulation. An esophagogastroduodenoscopy scope was then utilized to successfully traverse the sigmoid colon and ultimately reach the cecum. Diverticulosis of the whole colon was noted with polypectomy being performed on 2 polyps (3 mm-6 mm) in both the ascending and transverse colon respectively. There were no obvious complications noted right after the procedure. However, the patient did describe experiencing a sharp, left lower quadrant abdominal pain the day after the procedure was completed and was instructed to present to the Emergency Department. Computed tomography (CT) abdomen pelvis with contrast was obtained which was positive for diverticular changes and mucosal thickening with fat stranding of the sigmoid colon consistent with acute diverticulitis. The patient was admitted under observation, started on Zosyn overnight, and transitioned to fourteen-day course of augmentin for discharge the next day. Repeat computed tomography abdomen pelvis without contrast was completed roughly 1 month after discharge. Imaging showed pan diverticulosis with resolution of diverticulitis. Discussion: Post-colonoscopy diverticulitis is a rare occurrence. There are a few hypothesized factors that may contribute to the etiology such as: the direct pressure of the scope, barotrauma from insufflation, or exacerbation of “silent diverticulitis”. Along with perforation and appendicitis, post-colonoscopy diverticulitis should be considered in the differential of any patient presenting with abdominal pain and fever after colonoscopic evaluation.