Subscribe to RSS
DOI: 10.1055/s-0030-1247334
© Georg Thieme Verlag Stuttgart ˙ New York
Wie bedrohlich ist eine Divertikulitis: Was wissen wir über den Langzeitverlauf?
How Threatening is a Diverticulitis: What do we Know about the Long-Term Course?Publication History
Publication Date:
08 April 2010 (online)
![](https://www.thieme-connect.de/media/zblchir/201002/lookinside/thumbnails/10.1055-s-0030-1247334-1.jpg)
Zusammenfassung
Vor dem Hintergrund der fortbestehenden Kontroverse bezüglich der Therapiewahl bei der Kolondivertikulitis ohne diffuse Peritonitis – konservativ oder operativ – wird eine Analyse der diesbezüglichen Literatur vorgenommen. Unter Berücksichtigung der Fortschritte in Diagnostik und Therapie hat in den letzten 10 Jahren ein Paradigmenwechsel für die Operationsindikation stattgefunden. Wegen des Fehlens eines Vergleichs zwischen konservativer und operativer Therapie in prospektiv-randomisierten, kontrollierten Studien müssen Fragen zur Therapie der Divertikulitis – wie Operationszeitpunkt im Stadium II a / b oder Rezidivraten speziell nach konservativer Therapie – derzeit offen bleiben. Die Therapiewahl sollte von der individuellen Beschwerdesymptomatik, der Komorbidität und dem Patientenalter abhängig gemacht werden.
Abstract
In the context of the controversy regarding the appropriate management of colon diverticulitis without generalised peritonitis – conservative or operative – a review of the literature was performed. The progress in diagnostic and therapeutic measures has led to a change in the therapeutic approach during the last 10 years. Because of the lack of randomised controlled trials in patients with diverticulitis (without generalised peritonitis) comparing medical and surgical treatments, there are still several unanswered questions, such as whether and when to operate and what the recurrence rate is, especially after medical treatment. The therapeutic management should be oriented to the individual symptoms, the comorbidity and the age of the patients.
Schlüsselwörter
Divertikulitis - Stadien - Verlauf - Therapie
Key words
diverticulitis - stages - natural course - therapy
Literatur
- 1 Guzzo J, Hyman N. Diverticulitis in the young patients: is resection after a single attack always warranted. Dis Colon Rectum. 2004; 47 1187-1191
- 2 Anaya D A, Flum D R. Risk of emergency colectomy and colostomy in patients with diverticular disease. Arch Surg. 2005; 140 681-685
- 3 Aydin H N, Remzi F H. Diverticulitis: when and how to operate. Dig Liver Dis. 2004; 36 435-445
- 4 Parks T G. Natural history of diverticular disease of the colon. Clin Gastroenterol. 1975; 4 53-69
- 5 Waugh J M, Walt A J. Current trends in the surgical treatment of diverticulitis of the sigmoid colon. Surg Clin North Am. 1962; 43 1267-1276
- 6 Farmakis N, Tudor R G, Keighley M R. The 5-year natural history of complicated diverticular disease. Br J Surg. 1994; 81 733-735
- 7 Boles Jr R S, Jordan S M. The clinical significance of diverticulosis. Gastroenterology. 1958; 35 579-582
- 8 Hansen O, Stock W. Prophylaktische Operation bei der Divertikelkrankheit des Kolons – Stufenkonzept durch exakte Stadieneinteilung. Langenbecks Arch Chir (Suppl II). 1999; 1257-1260
- 9 Hinchey E J, Schaal P G, Richards G K. Treatment of perforated diverticular disease of the colon. Adv Surg. 1978; 12 85-109
- 10 Germer C T, Groß V. Divertikulitis: Wann konservativ, wann operativ behandeln. Deutsches Ärzteblatt. 2007; 50 3486-3491
- 11 Mueller M H, Glatzle J, Kasparek M S et al. Long-term outcome of conservative treatment in patients with diverticulitis of the sigmoid colon. Eur J Gastroenterol Hepatol. 2005; 17 649-654
- 12 Peppas G, Bliziotis I A, Oikonomaki D et al. Outcomes after medical and surgical treatment of diverticulitis: A systematic review of the available evidence. J Gastroenterol Hepatol. 2007; 22 1360-1368
- 13 Chapman J, Davis M, Wolff B et al. Complicated diverticulitis: is it time to rethink the rules. Ann Surg. 2005; 242 576-581
- 14 Chapman J, Dozois E J, Wolff B G et al. Diverticulitis: a progressive disease? Do multiple recurrences predict less favorable outcomes. Ann Surg. 2006; 243 876-883
- 15 Pautrat K, Bretagnol F, Huten N et al. Acute diverticulitis in very young patients: a frequent surgical management. Dis Colon Rectum. 2006; 49 1-6
- 16 Ambrosetti P, Robert J, Witzig J A et al. Prognostic factors from computed tomography in acute left colonic diverticulitis. Br J Surg. 1992; 79 117-119
- 17 Cunningham M A, Davis J W, Kaups K L. Medical versus surgical management of diverticulitis in patients under age 40. Am J Surg. 1997; 174 733-735
- 18 Ouriel K, Schwartz S l. Diverticular disease in the young patient. Surg Gynecol Obstet. 1983; 156 1-5
- 19 Vignati P V, Welch J P, Cohen J L. Long-term management of diverticulitis in young patients. Dis Col Rect. 1995; 38 627-629
- 20 Ambrosetti P, Becker C, Terrier F et al. Colonic diverticulitis: impact of imaging on surgical management: a prospective study of 542 patients. Eur Radiol. 2002; 12 1145-1149
- 21 Broderick-Villa G, Burchette R J, Collins J C et al. Hospitalization for acute diverticulitis does not mandate routine elective colectomy. Ach Surg. 2005; 140 576-581
- 22 Nelson R S, Velasco A, Mukesh B N. Management of the diverticulitis in younger patients. Dis Colon Rectum. 2006; 49 1341-1345
- 23 Hjern F, Josephson T, Altman D et al. Conservative treatment of acute coloric diverticulitis: are antibiotics always mandatory?. Scand J Gastroenterol. 2007; 42 41-47
- 24 Lahat A, Menachem Y, Avidan B et al. Diverticulitis in the young patient – is it different. World J Gastroenterol. 2006; 12 2932-2935
- 25 Rafferty J, Shellito P, Hyman N H et al. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum. 2006; 49 939-944
Prof. Dr. M. Betzler
Alfried Krupp Krankenhaus · Klinik für Allgemeine und Viszeralchirurgie · Unfall- und Gefäßchirurgie
Alfried-Krupp-Straße 21
45131 Essen
Deutschland
Phone: 02 01 / 4 34 25 35
Fax: 02 01 / 4 34 23 79
Email: michael.betzler@krupp-krankenhaus.de