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Diagnostik und Therapie des akuten Abdomens

Diagnosis and therapy of an acute abdomen

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An Erratum to this article was published on 15 October 2014

Zusammenfassung

Sowohl für den Notaufnahmearzt als auch den Intensivmediziner stellt der Patient mit einem „akuten Abdomen“ eine besondere Herausforderung dar. Dabei ist der sog. brettharte Bauch Resultat einer sekundären Peritonitis, die zwangsläufig in einer intraabdominellen Sepsis gipfelt. Diese kritisch kranken Patienten profitieren von einer möglichst raschen Diagnostik und interdisziplinären Therapie. Die Gruppe der Patienten mit einer postoperativen Peritonitis (z. B. nach Anastomoseninsuffizienz) weist oftmals ein maskiertes klinisches Bild auf, das ein Grund für die inakzeptabel hohe Letalität ist.

Nach Durchlaufen einer Standarddiagnostik wird die Indikation zur Computertomographie früh gestellt, da sie zusätzlich zur Fokussuche bereits eine Operationsplanung und ggf. eine radiologisch-interventionelle Drainageeinlage erlaubt. Die Therapie fußt auf 3 elementaren Säulen: der raschen Fokussanierung, einer breiten Antibiotikatherapie und den supportiven intensivmedizinischen Maßnahmen.

Abstract

Patients with signs of an acute abdomen continue to be a challenge for both the emergency physician and the intensivist. Clinical symptoms usually result from secondary peritonitis possibly progressing to intraabdominal sepsis. Critically ill patients need rapid diagnostic work-up and an interdisciplinary therapeutic approach. Among patients with secondary peritonitis, those with postoperative peritonitis (e.g., after anastomotic leakage) show a particularly high mortality because of unspecific symptoms. Beyond routine diagnostic procedures, patients with an acute abdomen often require a CT scan which helps to detect the septic focus, thereby often allowing an interventional source control. Therapy consists of three main elements: source control, broad-spectrum antimicrobial therapy, and supportive intensive care medicine.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A. Hecker, B. Hecker, K. Kipfmüller, J. Holler, E. Schneck, M. Reichert, M.A. Weigand, W. Padberg und M. Hecker geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland

    A. Hecker, K. Kipfmüller, J. Holler, M. Reichert & W. Padberg

  2. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Gießen, Deutschland

    B. Hecker, E. Schneck & M.A. Weigand

  3. Medizinische Klinik II, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Gießen, Deutschland

    M. Hecker

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  1. A. Hecker
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  4. J. Holler
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Correspondence to A. Hecker.

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Hecker, A., Hecker, B., Kipfmüller, K. et al. Diagnostik und Therapie des akuten Abdomens. Med Klin Intensivmed Notfmed 109, 445–458 (2014). https://doi.org/10.1007/s00063-013-0335-y

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