Zusammenfassung
Die Divertikulose ist eine Zivilisationserkrankung der westlichen Welt mit einer hohen Prävalenz, die mit zunehmendem Alter steigt. Als Risikofaktoren werden Bewegungsmangel und faserarme Ernährung diskutiert. Rund 70% der Patienten bleiben beschwerdefrei. Typische Komplikationen sind die Divertikulitis und die Blutung.
Eine Divertikulitis entsteht bei etwa 25% der Betroffenen. Dabei ist hauptsächlich das linke Hemikolon betroffen. Klinisch imponiert die Divertikulitis mit abdominellen Schmerzen und erhöhten Entzündungszeichen. Bei der Diagnostik stehen Sonographie und Computertomographie im Vordergrund. Die Therapie stützt sich auf passagere Nahrungskarenz, Antibiotikatherapie und Abszessdrainage bei komplizierten Verläufen. Eine Notfalloperation sollte auf schwere Verläufe mit Peritonitis beschränkt bleiben. Die Entscheidung zur elektiven Operation im Intervall ist eine individuelle Entscheidung, die vor allem nach einem guten Ansprechen auf eine konservative Therapie bei Erstmanifestation zurückhaltend getroffen wird.
Abstract
Diverticulosis is a civilization disease of western countries and the prevalence increases with age. Risk factors are lack of dietary fibre and low physical activity. Symptoms are reported in only 30% of patients. Complications are diverticular bleeding and diverticulitis.
Diverticulitis is a complication and presents in 20–30% of patients mostly involving the left colon. Diagnosis is based on clinical symptoms; ultrasound, computed tomography, and colonoscopy should be carried out at regular time intervals. The therapy is based on bowel rest, antibiotic therapy and in severe cases by percutaneous drainage of abscesses. Emergency surgery remains limited to peritonitis. The recommendation for elective surgery is changing to a conservative treatment, especially after a favorable response to conservative treatment and should be made on an individual basis.
Literatur
Brodribb AJ (1977) Treatment of symptomatic diverticular disease with a high-fibre diet. Lancet 1:664–666
Comparato G, Pilotto A, Franzè A (2007). Diverticular disease in the elderly. Dig Dis 25:151–159
Korzenik JR (2006). Case closed? Diverticulitis: Epidemiology and fiber. J Clin Gastroenterol 40 (Suppl 3): 112–116
Hjern F, Wolk A, Håkansson N (2012) Obesity, physical inactivity, and colonic diverticular disease requiring hospitalization in women: a prospective cohort study. Am J Gastroenterol 107: 296–302
Peery AF, Barrett PR, Park D et al (2012) A high-fiber diet does not protect against asymptomatic diverticulosis. Gastroenterology 142: 266–272
Crowe FL, Appleby PN, Allen NE, Key TJ (2011) Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and Nutrition (EPIC): prospective study of British vegetarians and non-vegetarians. BMJ 343: d4131
Niikura R, Nagata N, Akiyama J et al (2012) Hypertension and concomitant arteriosclerotic diseases are risk factors for colonic diverticular bleeding: a case-control study. Int J Colorectal Dis (Published online: 22 February 2012)
Floch MH, White JA (2006) Management of diverticular disease is changing. World J Gastroenterol 12: 3225–3228
Niikura R, Nagata N, Yamada A et al (2012) Recurrence of colonic diverticular bleeding and associated risk factors. Colorectal Dis 14: 302–305
Strate LL, Liu YL, Huang ES et al (2011) Use of aspirin or nonsteroidal anti-inflammatory drugs increases risk for diverticulitis and diverticular bleeding. Gastroenterology 140:1427–1433
Chang CH, Lin JW, Chen HC et al (2011) Non-steroidal anti-inflammatory drugs and risk of lower gastrointestinal adverse events: a nationwide study in Taiwan. Gut 60: 1372–1378
Ishii N, Setoyama T, Deshpande GA et al (2012) Endoscopic band ligation for colonic diverticular hemorrhage. Gastrointest Endosc 75: 382–387
Kaltenbach T, Watson R, Shah J et al (2012) Colonoscopy with clipping is useful in the diagnosis and treatment of diverticular bleeding. Clin Gastroenterol Hepatol 10: 131–137
Sai VF, Velayos F, Neuhaus J, Westphalen AC (2012) Colonoscopy after CT diagnosis of diverticulitis to exclude colon cancer: a systematic literature review. Radiology 263: 383–390
Karoui M, Champault A, Pautrat K et al (2009) Laparoscopic peritoneal lavage or primary anastomosis with defuctioning stoma for Hinchey 3 complicated diverticulitis: results of a comparative study. Dis Colon Rectum 52: 609–615
Favuzza J, Frield JC, Kelly JJ et al (2009) Benefits of laparoscopic peritoneal lavage for complicated sigmoid diverticulitis. Int J Colorectal Dis 24: 799–801
Pisanu A, Cois A, Uccheddu A (2004) Surgical treatment of perforated diverticular disease: evaluation of factors predicting prognosis in the elderly. Int Surg 89: 35–38
Herverhagen JT, Sitter H, Zielke A, Klose KJ (2008) Prospective evaluation of the value of magnetic resonance imaging in suspected acute sigmoid diverticulitis. Dis Colon Rectum 51: 1810–1815
Sakhnini E, Lahat A, Melzer E (2004) Early colonoscopy in patients with acute diverticulitis: results of a prospective pilot study. Endoscopy 36: 504–507
Schwerk WB, Schwarz S, Rothmund M (1992) Sonography in acute colonic diverticulitis. A prospective study. Dis Col Rect 35: 1077–1084
Mazuski JE, Sawyer RG, Nathens AB (2002). The surgical infection society guidelines on antimicrobial therapy for intra-abdominal infections: evidence for the recommendations. Surg Infect 3: 175–233
Gatta L, Vakil N, Vaira D et al (2010) Efficacy of 5-ASA in the treatment of colonic diverticular disease. J Clin Gastroenterol 44: 113–119
Drusano Gl, Warren JW, Saah AJ et al (1982) A prospective randomized controlled trial of cefoxitin versus clindamycin aminoglycoside in mixed anaerobic-aerobic infections. Surg Gynecol Obstet 154: 715–720
Kotzampassakis N, Pittet O, Schmidt S et al (2010) Presentation and treatment outcome of diverticulitis in younger adults: a different disease than in older patients? Dis Colon Rectum 53: 333–338
Kaiser AM, Jiang JK, Lake JP et al (2005) The management of complicated diverticulitis and the role of computed tomography. Am J Gastroenterol 100: 910–917
Fleming FJ, Gillen P (2009) Reversal of Hartmann’s procedure following acute diverticulitis: is timing everything? Int J Colorectal Dis 24: 1219–1225
Biondo S, Lopez Borao J, Millan M et al (2012) Current status of the treatment of acute colonic diverticulitis: a systematic review. Colorectal Dis 14: e1–e11
Trenti L, Biondo S, Golda T et al (2011) Generalized peritonitis due to perforated diverticulitis: Hartmann’s procedure or primary anastomosis? Int J Colorectal Dis 26: 377–384
Salem L, Flum DR (2004) Primary anastomosis or Hartmann’s procedure for patients with diverticular peritonitis? A systematic review. Dis Colon Rectum 47: 1953–1964
Latella G, Pimpo MT, Sottili S et al (2005) Rifaximin improves symptoms of acquired uncomplicated diverticular disease of the colon. Int J Colorectal Dis 18: 55–62
Martel J, Raskin JB, NDSG (2008) History, incidence, and epidemiology of diverticulosis. J Clin Gastroenterol 42: 1125–1127
Wess L, Eastwood MA, Wess TJ et al (1995) Cross linking of collagen is increased in colonic diverticulosis. Gut 37: 91–94
Tursi A, Brandimarte G, Giorgetti GM, Elisei W (2005) Assessment of small intestinal bacterial overgrowth in uncomplicated acute diverticulitis of the colon. World J Gastroenterol 11: 2773–2776
Simpson J, Neal KR, Scholefield JH (2003) Patterns of pain in diverticular disease and the influence of acute diverticulitis. Eur J Gastroenterol Hepatol 15: 1005–1010
Longstreth GF (1997) Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 92: 419–424
Laine L, Shah A (2010) Randomized trail of urgent vs. elekticve colonoscopy in patients hospitalized with lower GI bleeding. Am J Gastroenterol 105: 2636–2641
Murphy T, Hunt RH, Fried M, Krabshuis JH (2007) World Gastroenterology Organisation practice guidelines: diverticular disease. Milwaukee: WGO
Tan KK, Wong D, Sim R (2008) Superselective embolization for lower gastrointestinal hemorrhage: an institutional review over 7 years. World J Surg 32: 2707-271
Interessenkonflikt
Der korrespondierende Autor gibt für sich und seinen Koautor an, dass kein Interessenskonflikt besteht.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Schmidt, EM., Jakobs, R. Divertikulose und Divertikulitis im Alter. Gastroenterologe 7, 320–325 (2012). https://doi.org/10.1007/s11377-012-0660-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11377-012-0660-3