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Divertikulose und Divertikulitis im Alter

Diverticulosis and diverticulitis in the elderly

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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.

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Schmidt, EM., Jakobs, R. Divertikulose und Divertikulitis im Alter. Gastroenterologe 7, 320–325 (2012). https://doi.org/10.1007/s11377-012-0660-3

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