ABSTRACT
Gallbladder polyp (GBP) is a common yet often incidental finding in abdominal imaging. Gallbladder cancer is a rare disease with a high mortality due to late onset of symptoms and diagnostics. Most GBPs are pseudopolyps which do not undergo malignant transformation, however some are true neoplastic polyps with a malignant potential. In this review based on newly published international guidelines we recommend management in terms of assessment of individual risk factors as well as ultrasound features associated with risk of malignancy. A diagram with suggested algorithm is provided.
Subject(s)
Gallbladder Diseases , Gallbladder Neoplasms , Gastrointestinal Neoplasms , Polyps , Humans , Follow-Up Studies , Gallbladder Diseases/diagnosis , Gallbladder Diseases/pathology , Gallbladder Neoplasms/diagnostic imaging , Polyps/diagnostic imaging , Ultrasonography , Retrospective StudiesABSTRACT
INTRODUCTION: Danish guidelines recommend colonoscopy after a case of acute diverticulitis to exclude colorectal cancer (CRC), but evidence in support this practice is limited. A series of studies has reported a low incidence of CRC in patients after they presented with acute diverticulitis, especially in uncomplicated cases. The purpose of this study was to investigate the incidence of CRC after acute diverticulitis detected during colonoscopy. METHODS: All patients seen between January 2010 and November 2017 with a first episode of acute diverticulitis and a subsequent computed tomography and colonoscopy were included. RESULTS: A total of 332 patients were included in the study. The incidence of CRC after a case of uncomplicated acute diverticulitis was 0.8%. The incidence of malignancy was 2.8% in the group of patients with complicated diverticulitis. CONCLUSIONS: This study showed a low risk of CRC after a case of acute diverticulitis and no cases of CRC in patients with uncomplicated diverticulitis without clinical symptoms of CRC. This indicates that revising guidelines in regards to follow-up after diverticulitis may be warranted. FUNDING: none. TRIAL REGISTRATION: not relevant.
Subject(s)
Colorectal Neoplasms , Diverticulitis, Colonic , Diverticulitis , Colonoscopy/adverse effects , Colorectal Neoplasms/epidemiology , Colorectal Neoplasms/etiology , Diverticulitis/complications , Diverticulitis/etiology , Diverticulitis, Colonic/complications , Diverticulitis, Colonic/diagnostic imaging , Diverticulitis, Colonic/epidemiology , Humans , Retrospective StudiesABSTRACT
According to international guidelines, patients presenting with acute diverticulitis are offered lower endoscopy to rule out colorectal cancer. This practice is based on weak evidence. Recent studies have established that the incidence of colorectal cancer after acute diverticulitis is low. In case of complicated diverticulitis, with abscess or perforation, the incidence of colorectal cancer is higher. There is, thus, a lack of evidence supporting colonoscopy by uncomplicated diverticulitis, but if a patient presents with complicated diverticulitis, colonoscopy should be performed.
Subject(s)
Colonoscopy , Diverticulitis, Colonic , Diverticulitis , Acute Disease , Humans , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Anastomotic leak (AL) is one of the most severe complications after colorectal surgery. AL is often diagnosed late when the patient is presenting with septic symptoms. C-reactive protein (CRP) as a tool in the diagnosis of AL has been investigated in several studies. CRP is proven to have a high negative predictive value which allows safe discharge of patients with low CRP measurements on day 3 or 4 after surgery. CRP can assist in the diagnosis of AL but cannot be used as a single parameter.
