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Der Chirurg

, Volume 85, Issue 4, pp 281–288 | Cite as

Anatomie und Pathogenese der Divertikelkrankheit

  • T. Wedel
  • M. Böttner
Leitthema

Zusammenfassung

Hintergrund

Obwohl die Divertikelkrankheit zu den häufigsten gastrointestinalen Erkrankungen zählt, ist die Pathogenese nur unzureichend geklärt.

Fragestellung

Ziel der Arbeit ist Beschreibung der Anatomie und Pathogenese der Divertikelkrankheit unter Berücksichtigung der Risikofaktoren und die Darstellung struktureller und funktioneller Veränderungen der Darmwand.

Material und Methode

Anhand einer Literaturauswertung werden tradierte ätiologische Faktoren der Divertikelkrankheit dargestellt und bewertet sowie neue pathogenetische Konzepte analysiert und diskutiert.

Ergebnisse

Als Kolondivertikulose wird die erworbene Ausstülpung von multiplen, zunächst reizlosen Pseudodivertikeln durch Muskellücken der Kolonwand bezeichnet. Die Divertikelkrankheit ist gekennzeichnet durch Divertikelblutungen und/oder entzündliche Veränderungen (Divertikulitis) mit entsprechenden Komplikationen (Abszess- und Fistelbildung, gedeckte und offene Perforation, Peritonitis, Stenosierung). Risikofaktoren für die Divertikelkrankheit sind zunehmendes Alter, genetische Prädisposition, erbliche Bindegewebserkrankungen, ballaststoffarme Ernährung, hoher Fleischkonsum und ausgeprägtes Übergewicht. Veränderungen des Bindegewebes führen zur Schwächung der präfomierten Austrittsstellen der Divertikel und zur Versteifung der Darmwand mit verminderter Rückstellfähigkeit. Es wird vermutet, dass intestinale Innervationsstörungen und strukturelle Veränderungen der Muskulatur zu abnormen Kontraktilitätsmustern mit erhöhtem intraluminalem Druck führen, die der Divertikelausbildung Vorschub leisten. Eine vermehrte Ausschüttung schmerzvermittelnder Neurotransmitter wird für die persistierende Schmerzsymptomatik bei chronischen Verläufen verantwortlich gemacht.

Schlussfolgerungen

Aufgrund der aktuellen Datenlage lässt sich die Pathogenese der Divertikelkrankheit nicht auf einen singulären Faktor zurückführen, sondern muss als ein multifaktorielles Geschehen angesehen werden.

Schlüsselwörter

Divertikelkrankheit Ernährung Enterisches Nervensystem Enterische Muskulatur Intestinale Motilität 

Anatomy and pathogenesis of diverticular disease

Abstract

Background

Although diverticular disease is one of the most frequent gastrointestinal disorders the pathogenesis is not yet sufficiently clarified.

Objectives

The aim is to define the anatomy and pathogenesis of diverticular disease considering the risk factors and description of structural and functional alterations of the bowel wall.

Methods

This article gives an appraisal of the literature, presentation and evaluation of classical etiological factors, analysis and discussion of novel pathogenetic concepts.

Results

Colonic diverticulosis is defined as an acquired out-pouching of multiple and initially asymptomatic pseudodiverticula through muscular gaps in the colon wall. Diverticular disease is characterized by diverticular bleeding and/or inflammatory processes (diverticulitis) with corresponding complications (e.g. abscess formation, fistula, covered and open perforation, peritonitis and stenosis). Risk factors for diverticular disease include increasing age, genetic predisposition, congenital connective tissue diseases, low fiber diet, high meat consumption and pronounced overweight. Alterations of connective tissue cause a weakening of preformed exit sites of diverticula and rigidity of the bowel wall with reduced flexibility. It is assumed that intestinal innervation disorders and structural alterations of the musculature induce abnormal contractile patterns with increased intraluminal pressure, thereby promoting the development of diverticula. Moreover, an increased release of pain-mediating neurotransmitters is considered to be responsible for persistent pain in chronic diverticular disease.

Conclusions

According to the present data the pathogenesis of diverticular disease cannot be attributed to a single factor but should be considered as a multifactorial event.

Keywords

Diverticular disease Nutrition Enteric nervous system Enteric musculature Intestinal motility 

Notes

Danksagung

Die Autoren danken Frau Bettina Facompré, Frau Inka Geurink, Frau Miriam Lemmer, Frau Karin Stengel sowie Herrn Clemens Franke für die Hilfe bei den Labor- und Fotoarbeiten.

Einhaltung ethischer Richtlinien

Interessenkonflikt: T. Wedel und M. Böttner geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Anatomisches InstitutChristian-Albrechts-Universität KielKielDeutschland

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