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Behandlungsstrategien und Operationsindikationen bei chronischer Divertikulitis

Treatment strategies and indications for surgery in chronic diverticulitis

  • Leitthema
  • Published:
coloproctology Aims and scope

Zusammenfassung

Von einer chronischen Divertikulitis spricht man bei persistierenden oder rezidivierenden Entzündungsschüben, die zu Komplikationen wie Fisteln, Stenosen oder entzündlichen Konglomerattumoren führen können. Das Rezidivrisiko nach einer Episode einer akuten Divertikulitis liegt bei etwa 11–19 % und steigt mit jeder Entzündungsepisode an, wobei nachfolgende Divertikulitisschübe nicht aggressiver verlaufen als vorherige Episoden. Ein besseres Verständnis des natürlichen Verlaufs der Divertikulitis hat zu einer signifikanten Änderung der Behandlungsstrategie der rezidivierenden Divertikulitis geführt. Die Anzahl der stattgehabten Episoden wird nicht mehr als Kriterium für die Indikation zur Operation verwendet, da die Mehrzahl der Divertikulitisrezidive milde verläuft und konservativ behandelt werden kann. Die Entscheidung zur operativen Therapie sollte individuell vom Beschwerdebild des Patienten abhängig gemacht werden, wobei insbesondere die Beeinträchtigung der Lebensqualität durch die rezidivierende Erkrankung bei Indikationsstellung zu berücksichtigen ist. Im Fall von Komplikationen wie Fisteln oder Stenosen sollte eine elektive Operation indiziert werden.

Abstract

Chronic diverticulitis refers to persistent or recurring inflammatory episodes that can lead to complications, such as fistulas, stenosis or inflammatory conglomerate tumors. The risk of recurrence after an episode of acute diverticulitis is about 11–19% and increases with each episode of inflammation, with subsequent flares of diverticulitis being no more aggressive than the previous episodes. A better understanding of the natural history of diverticulitis has led to a significant change in the treatment strategy for recurrent diverticulitis. The number of episodes that have occurred is no longer used as a criterion for the indications for surgery as the majority of diverticulitis recurrences are mild and can be treated conservatively. The decision for surgical treatment should be made individually depending on the patient’s symptoms, whereby the impairment of quality of life due to the recurrent disease in particular must be taken into account when determining the indications. In the event of complications such as fistulas or stenoses, elective surgery should be indicated.

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Authors and Affiliations

  1. Klinik für Allgemein- und Viszeralchirurgie, St. Joseph Krankenhaus Berlin Tempelhof, Wüsthoffstr. 15, 12101, Berlin, Deutschland

    C. Holmer

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Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Holmer, C. Behandlungsstrategien und Operationsindikationen bei chronischer Divertikulitis. coloproctology 45, 159–162 (2023). https://doi.org/10.1007/s00053-023-00699-0

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