Subscribe to RSS
DOI: 10.1055/s-2001-11141
Larvierte perforierte Sigmadivertikulitis auf dem Boden einer systemischen Immunsuppression
Publication History
Publication Date:
31 December 2001 (online)
![](https://www.thieme-connect.de/media/viszeralchirurgie/200101/lookinside/thumbnails/10.1055-s-2001-11141-1.jpg)
Zusammenfassung.
Als häufigste benigne Erkrankung des Kolons kommt der Sigmadivertikulitis eine besondere Bedeutung zu. Ätiologie und Pathogenese der Divertikulitis sind noch nicht hinreichend geklärt. Septischen Komplikationen muss aufgrund ihres lebensbedrohlichen Charakters besondere Aufmerksamkeit gewidmet werden. Dies gilt insbesondere für Patienten mit systemischer Immunsuppression im Rahmen einer Organtransplantation, Chemotherapie oder einer medikamentösen Therapie bei chronischen Erkrankungen. Wir berichten über einen 61-jährigen Patienten mit metastasierendem Bronchialkarzinom, bei dem infolge einer Immunsuppression und Schmerztherapie die Perforation einer Sigmadivertikulitis auftrat. Diese war als Zufallsbefund bei der radiologischen Diagnostik im Rahmen der Strahlentherapie als freie intraabdominelle Luft erkannt worden. Bei immunsupprimierten Patienten muss daher bei Auftreten geringster Symptome eine Komplikation vorbestehender entzündlicher Darmerkrankungen mitbedacht und eine früh-elektive Resektion angestrebt werden.
Larvate perforated sigmoid diverticulitis following systemic immunosuppression.
Being the most frequent benign disease of the large bowel sigmoid diverticulitis plays an important role. There is yet no certainty about its aetiology and pathogenetic factors. Because of their life-threatening character we should focus our attention onto septic complications of diverticulitis. In particular, patients with a systemic immunosuppression, either following organ transplantation, due to chemotherapy, or as a treatment of other chronic diseases, have to be mentioned. We report the case of a 61-year old male patient suffering from a metastatic bronchogenic carcinoma who experienced the perforation of a sigmoid diverticulum after an immunocompromizing and analgetic drug therapy. The perforation was an incident finding during conventional diagnostic radiology (free subdiaphragmatic air) for radiotherapy. We conclude that in the immunosuppressed patient the complication of a pre-existing inflammatory bowel disease can be almost asymptomatic and thus should be included in diagnostic thinking. An early elective resection should be performed.
Schlüsselwörter:
Sigmadivertikulitis - Immunsuppression - Perforation
Key words:
Sigmoid diverticulitis - immunosuppression - perforation
Literatur
- 1 Almy P P, Howell D A. Diverticular disease of the colon. NEJM. 1980; 302 324-331
- 2 Brown K M. Isolated ascending colon ulceration in a patient with chronic renal insufficiency. J Natl Med Assoc. 1992; 84 (2) 185-187
- 3 Carson S D, Krom R A, Uchida K, Yokota K, West J C, Weil R. Colon perforation after kidney transplantation. Ann Surg. 1978; 188 (1) 109-113
- 4 Church J M, Fazio V W, Braun W E, Novick A C, Steinmüller D R. Perforation of the colon in renal homograft recipients. A report of 11 cases and a review of the literature. Ann Surg. 1986; 203 69-76
- 5 Detry O, Defraigne J O, Meurisse M, Bertrand O, Demoulin J C, Honore P, Jacquet N, Limet R. Acute diverticulitis in heart transplant recipients. Transpl Int. 1996; 9 (4) 376-379
- 6 Dominguez Fernandez E, Albrecht K H, Heemann U, Kohnle M, Erhard J, Stoblen F, Eigler F W. Prevalence of diverticulosis and incidence of bowel perforation after kidney transplantation in patients with polycystic kidney disease. Transpl Int. 1998; 11 (1) 28-31
- 7 Faucheron J L, Parc R. Non-steroidal anti-inflammatory drug-induced colitis. Int J Colorectal Dis. 1996; 11 (2) 99-101
- 8 Faucheron J L. Toxicity of non-steroidal anti-inflammatory drugs in the large bowel. Eur J Gastroenterol Hepatol. 1999; 11 (4) 389-392
- 9 Fenton J J, Cicale M J. Sigmoid diverticular perforation complicating lung transplantation. J Heart Lung Transplant. 1997; 16 (6) 681-685
- 10 Goeters C, Buchholz B, Winde G. Perforation of sigmoid diverticula. A complication following allogenic kidney transplantation. Zentralbl Chir. 1988; 113 (23) 1525-1529
- 11 Gut A, Halter F, Ruchti C. Nonsteroidal antirheumatic drugs and acetylsalicylic acid: adverse effects distal to the duodenum. Schweiz Med Wochenschr. 1996; 126 (15) 616-625
- 12 Lux G, Langer M, Stabenow-Lohbauer U, Orth K H, Bozkurt T, Meyer M J. Divertikulose und Divertikulitis beim alten Menschen. Fortschr Med. 1998; 116 (9) 26 - 28-30, 32 - 34
- 13 Meyers W C, Harris N, Stein S, Brooks M, Jones R S, Thompson W M, Stickel D L, Seigler H F. Alimentary tract complications after renal transplantation. Ann Surg. 1979; 190 (4) 535-542
- 14 Mona D, Largiader F, Binswanger U, Sulser H. Colonic complications after renal transplantation. Langenbecks Arch Chir. 1982; 357 (2) 141-150
- 15 Morton D G, Keighley M RB. Prospective nationale Studie zur komplizierten Sigmadivertikulitis. Chirurg. 1995; 66 1173-1176
- 16 Pirenne J, Lledo-Garcia E, Benedetti E, West M, Hakim N S, Sutherland D E, Gruessner R W, Najarian J S, Matas A J. Colon perforation after renal transplantation: a single-institution review. Clin Transplant. 1997; 11 (2) 88-93
- 17 Rege R V, Nahrwold D L. Diverticular disease. Curr Probl Surg. 1989; 26 (3) 133-189
- 18 Rodkey G V, Welch C E. Changing patterns in the surgical treatment of diverticular disease. Ann Surg. 1984; 200 (4) 466-478
- 19 Sawyerr O I, Garvin P J, Codd J E, Graff R J, Newton W T, Willmann V L. Colorectal complications of renal allograft transplantation. Arch Surg. 1978; 113 (1) 84-86
- 20 Schulz C, Lemmens H P, Weidemann H, Rivas E, Neuhaus P. Resection with primary anastomosis in complicated diverticulitis. Risk analysis. Chirurg. 1994; 65 (1) 50-53
- 21 Siewert J R, Huber F T, Brune I B. Frühelektive Chirurgie der akuten Divertikulitis des Colons. Chirurg. 1995; 66 1182-1189
- 22 Starnes H F, Lazarus J M, Vineyard G. Surgery for diverticulitis in renal failure. Dis Colon Rectum. 1985; 28 827-831
- 23 Tyau E S, Prystowsky J B, Joehl R J, Nahrwold D L. Acute diverticulitis. A complicated problem in the immunocompromised patient. Arch Surg. 1991; 126 (7) 855-859
Dr. med. Marc Voshege
Chirurgische AbteilungMarien-Hospital
Rochusstr. 2
40479 Düsseldorf