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Viszeralchirurgie 2003; 38(1): 21-26
DOI: 10.1055/s-2003-37291
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Appendizitis - Problematik der Perforation

Acute Appendicitis - The Obstacle of PerforationA.  Wilhelm1 , C.  Langer1 , C.  W.  Kley1 , H.  Becker1
  • 1Klinik und Poliklinik für Allgemeinchirurgie, Georg-August-Universität Göttingen
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Publication History

Publication Date:
18 February 2003 (online)

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Zusammenfassung

Die akute Appendizitis stellt die häufigste Notfalloperation in der Allgemeinchirurgie dar. Trotz moderner Bildgebung sind zum Operationszeitpunkt weiterhin noch 20 - 30 % der Appendizitiden perforiert. Diese Quote konnte in den letzten 15 Jahren nicht substanziell und dauerhaft reduziert werden. Die Perforation resultiert in einer erhöhten Morbidität für den Patienten bei verlängerter Krankenhausverweildauer und erheblichen sozioökonomischen Folgekosten. Im Rahmen dieser Übersichtsarbeit wird gezeigt, dass die Behandlung der Erkrankung weder durch die Haus- noch durch die Krankenhausärzte verzögert wird. Einzig die Patienten verzögern z. T. selbst durch zu langes Abwarten bis zum ersten Arztkontakt die rechtzeitige Weiterbehandlung. Moderne bildgebende Verfahren werden in ihrer Wertigkeit für die Diagnose der Perforation evaluiert und chirurgische Operationstechniken diskutiert. Zudem werden diagnostische Hilfsmittel wie Computermodelle und Scoring-Syteme sowie konservative Behandlungsstrategien angesprochen. Insgesamt erscheint eine Perforationsrate von bis zu 25 % dem Spontanverlauf der Erkrankung zu entsprechen. Dieses wird auch zukünftig nur schwer durch die betreuenden Ärzte abzusenken sein, obwohl dem Arzt mit modernen bildgebenden Verfahren und anderen diagnostischen Hilfsmitteln z. T. sehr nützliche Verfahren in der Diagnostik zur Verfügung stehen.

Abstract

Acute appendicitis is the most common emergency operation in general surgery. Regardless of improved imaging techniques there is still a perforation rate of 20 - 30 % at the time of surgery. This rate could not be substantially reduced within the last 15 years. Perforation results in a higher morbidity, prolonged hospital course and greater costs. In this review we are able to demonstrate, that the course of the disease was not delayed by the primary care physician or the surgeon. But patients were in part self-responsible for a delay in treatment because of a postponed primary care physician contact. Furthermore we evaluate modern radiological imaging techniques for their diagnostic accuracy in perforating appendicitis and discuss surgical operating methods. Moreover computer models and scoring systems along with conservative treatment strategies are mentioned. In summary, a perforation rate of 25 % reflects the spontaneous course of the disease. In prospect it will be difficult for the physicians to lower this rate. Although by means of modern imaging techniques and supporting diagnostic systems the physician finds helpful tools to improve the diagnostic quality.

Schlüsselwörter

Perforierte Appendizitis

Key words

Perforated appendicitis - review

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Dr. med. Arne Wilhelm

Klinik und Poliklinik für Allgemeinchirurgie, Georg-August-Universität

Robert-Koch-Straße 40

37075 Göttingen

Phone: + 49-551-396170

Fax: + 49-551-396106

Email: awilhelm@chirurgie-goettingen.de