Divertikulitis – Konservative Therapie

Zusammenfassung

Hintergrund: Die Divertikulitis als Folge der ­Kolondivertikulose ist ein häufiges klinisches Problem mit hoher Morbidität und sozioökonomischen Folgen. Blähungen, Bauchschmerzen, Stuhlprobleme sind häufige klinische Zeichen, die einem Reizdarm oder einer Kolitis oft zum Verwechseln ähnlich sind. Entsprechend adäquat muss die Diagnostik sein, um eine stadienadaptierte Therapie planen und durchführen zu können.
Material und Methoden: In der folgenden Übersicht sollen folgende Fragen beantwortet werden: Wie sichere ich die Diagnose? Welche Antibiotika werden eingesetzt? Wer muss stationär und wer ambulant behandelt werden? Wie sieht die konservative Therapie aus? Welche neuen konservativen Optionen gibt es?
Ergebnisse / Schlussfolgerung: Zur konservativen Basistherapie zählt die systemische Antibiose, die zukünftig erweitert werden könnte um eine topische Antibiose, 5-ASA und Probiotika-Gabe. Die Indikation zur spezifischen Therapie sollte ­jedoch am Einzelfall und abhängig von der Stadieneinteilung (nach Hansen und Stock) im interdisziplinären Konsens mit der Viszeralchirurgie erfolgen. 

Abstract

Background: Diverticulitis due to diverticulosis of the colon is a common clinical problem with a high morbidity and socio-economic consequences. Frequent clinical signs are flatulence, abdominal pain, stool problems which may often be misinterpreted as the symptoms of an irritable bowel or a colitis. Accordingly, the diagnostic work-up must be adequate to allow for the stage-adapted planning and performance of the therapy.
Material and Methods: The following questions will be addressed in this review: What do we need to clarify diagnosis? Which antibiotics should be used? What is the best conservative approach for treatment?
Results and Conclusions: Basic conservative ther­apy consists of systemic antibiosis which can be extended by a topical antibiosis, and administration of aspirin as well as probiotics. The indica­tions for a specific therapy is made on an individ­ual basis accoridng to stage (Hansen and Stock). Above all, a “team approach” and close com­mu­nica­tion between gastroenterologists and sur­geons are mandatory for adequate treatment of these patients.

Schlüsselwörter

akutes Abdomen - Divertikulitis - konservative Therapie

Key words

acute abdomen - diverticulitis - conservative therapy

• Literatur

• Telling WHM. Discussion on diverticlulits. Proc R Soc Med 1920; 13: 55-64
• Parks TG. Natural history of diverticular disease of the colon. Clin Gastroenterol 1975; 4: 53-69
• Kang JY, Hoare J, Tinto A et al. Diverticular disease of the colon – on the rise: a study of hospital admissions in England between 1989 / 1990 and 1999 / 2000. Aliment Pharmacol Ther 2003; 17: 1189-1195
• Gross V, Germer CT. Diverticular disease and diverticulitis. Dtsch Med Wochenschr 2008; 133: 1437-1446
• Tursi A, Papagrigoriadis S. Review article: the current and evolving treatment of colonic diverticular disease. Aliment Pharmacol Ther 2009; 30: 532-545
• Hoffmann RM, Kruis W. Divertikulose und Divertikulitis. Internist 2005; 46: 671-684
• Korzenik JR. Case closed? Diverticulitis: epidemiology and fiber. J Clin Gastroenterol 2006; 40: 112-116
• Aldoori WH, Giovannucci EL, Rimm EB et al. A prospective study of diet and the risk of symptomatic diverticular disease in men. Am J Clin Nutr 1994; 60: 757-764
• Nakaji S, Sugawara K, Saito D et al. Trends in dietary fiber intake in ­Japan over the last century. Eur J Nutr 2002; 41: 222-227
• Shepherd NA. Diverticular disease and chronic idiopathic inflamma­tory bowel disease: associations and masquerades. Gut 1996; 38: 801-802
• Ambrosetti P, Jenny A, Becker C et al. Acute left colonic diverticulitis: compared performance of computed tomography and water-soluble contrast enema: prospective evaluation of 420 patients. Dis Colon Rectum 2000; 43: 1363-1367
• Doringer E. Computerized tomography of colonic diverticulitis. Crit Rev Diagn Imaging 1992; 33: 421-435
• Chapman J, Davies M, Wolff B et al. Complicated diverticulitis: is it time to rethink the rules?. Ann Surg 2005; 242: 576-581
• Chapman JR, Dozois EJ, Wolff BG et al. Diverticulitis: a progressive disease? Do multiple recurrences predict less favorable outcomes?. Ann Surg 2006; 243: 876-880
• Kaiser AM, Jiang JK, Lake JP et al. The management of complicated diverticulitis and the role of computed tomography. Am J Gastroenterol 2005; 100: 910-917
• Siewert JR, Huber FT, Brune IB. [Early elective surgery of acute diverticulitis of the colon]. Chirurg 1995; 66: 1182-1189
• Lahat A, Menachem Y, Avidan B et al. Diverticulitis in the young patient – is it different?. World J Gastroenterol 2006; 14: 2932-2935
• Schechter S, Mulvey J, Eisenstat TE. Management of uncomplicated acute diverticulitis: results of a survey. Dis Colon Rectum 1999; 42: 470-475
• Hjern F, Josephson T, Altman D et al. Conservative treatment of acute ­colonic diverticulitis: are antibiotics always mandatory?. Scand J Gastroenterol 2007; 42: 41-47
• Germer CT, Jurowich C, Isbert C. Divertikulitis: OP-Indikation und Zeitpunkt des chirurgischen Eingriffs. Endo Heute 2006; 19: 165-172
• Kumar RR, Kim JT, Haukoos JS et al. Factors affecting the successful management of intra-abdominal abscesses with antibiotics and the need for percutaneous drainage. Dis Colon Rectum 2006; 49: 183-189
• Anaya DA, Flum DR. Risk of emergency colectomy and colostomy in patients with diverticular disease. Arch Surg 2005; 140: 681-685
• Betzler M. How Threatening is a Diverticulitis: What do we Know about the Long-Term Course?. Zentralbl Chir 2010; 135: 121-123
• Richter S, Lindemann W, Kollmar O et al. One-stage sigmoid colon resection for perforated sigmoid diverticulitis (Hinchey stages III and IV). World J Surg 2006; 30: 1027-1032
• Janes S, Meagher A, Frizelle FA. Elective surgery after acute diverticulitis. Br J Surg 2005; 92: 133-142
• Mueller MH, Glatzle J, Kasparek MS et al. Long-term outcome of conservative treatment in patients with diverticulitis of the sigmoid colon. Eur J Gastroenterol Hepatol 2005; 17: 649-654
• Peppercorn MA. The overlap of inflammatory bowel disease and diverticular disease. J Clin Gastroenterol 2004; 38: 8-10
• Floch MH. A hypothesis: is diverticulitis a type of inflammatory bowel disease?. J Clin Gastroenterol 2006; 40 (Suppl. 03) 121-125
• Banerjee S, Akbar N, Moorhead J et al. Increased presence of serotonin-producing cells in colons with diverticular disease may indicate in­volve­ment in the pathophysiology of the condition. Int J Colorectal Dis 2007; 22: 643-649
• Di Mario F, Comparato G, Fanigliulo L et al. Use of mesalazine in diverticular disease. J Clin Gastroenterol 2006; 40 (Suppl. 03) 155-159
• Gillis JC, Brogden RN. A review of its antibacterial activity, pharmaco­kinetic properties and therapeutic potential in conditions mediated by gastrointestinal bacteria. Drugs 1995; 49: 467-484