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Perforationsrisiko und Patientenalter

Eine Risikoanalyse bei der akuten Sigmadivertikulitis

Perforation risk and patient age

Risk analysis in acute sigmoid diverticulitis

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Zusammenfassung

Hintergrund

Es wird immer wieder postuliert, dass junge Patienten mit Sigmadivertikulitis (SD) ein erhöhtes Perforationsrisiko aufweisen und daher frühzeitig eine Indikation zur Operation gestellt werden müsse. Ziel dieser Studie war es, den Schweregrad der SD mit dem Patientenalter zu korrelieren, um die Operationsindikation bei jungen Patienten zu überprüfen.

Patienten und Methoden

In die Studie eingeschlossen wurden alle Patienten mit akuter SD im Zeitraum von Januar 1998 bis Juni 2009. Unterschieden wurde Gruppe I (G I) ≤40 Jahre von Gruppe II (G II) >40 Jahre. Hinsichtlich des Perforationsrisikos beim Erstereignis erfolgte eine multivariate Analyse. Die Einteilung der SD erfolgte nach Hansen und Stock (H/S).

Ergebnisse

Von 959 Patienten (86 [8,9%] ≤40 Jahre, 873 [91,1%] >40 Jahre) hatten 468 (64 [13,7%] ≤40 Jahre, 404 [86,3%] >40 Jahre) ein Erstereignis. Die Erstereignisrate betrug 74,4% in G I und 46,3% in G II (p<0,001). Das Perforationsrisiko unterschied sich nicht (H/S IIb: 29,7% G I vs. 29,2% G II, p=0,938; H/S IIc: 25% G I vs. 25% G II, p=1). Das therapeutische Regime war wie folgt: Notfalloperation 25% vs. 25% (p=1); elektive Operation 17,2% vs. 10% (p=0,096); konservativ 57,8% vs. 64,9% (p=0,276) (jeweils G I vs. G II).

Schlussfolgerung

Patienten ≤40 Jahre haben häufiger Erstereignisse einer SD und weisen dabei kein erhöhtes Perforationsrisiko auf. Die Indikation zur Therapie sollte nicht vom Alter, sondern vom Entzündungsausmaß und der individuellen Situation des Patienten abhängig gemacht werden.

Abstract

Introduction

It is often postulated that younger patients with acute sigmoid diverticulitis (SD) have an increased risk of perforation which constitutes an indication for early surgery. The aim of this study was to correlate the severity of sigmoid diverticulitis with patient age in order to check the surgical indication in younger patients.

Patients and methods

Patients with acute SD from January 1998 to June 2009 were included. Two age groups were distinguished: group I (GI) ≤40 years in age and group II (GII) >40 years. The perforation risk associated with first episode SD was determined by multivariate analysis. SD was classified according to Hansen and Stock (H/S).

Results

In the total cohort of 959 patients, including86 in GI (8.9%) and 873 in GII (91.1%) 468 had a first episode, with 64 in GI (13.7%) and 404 in GII (86.3%). The proportion of first episodes was 74.4% in GI and 46.3% in GII (p<0.001). The perforation risk did not differ (H/S IIb: 29.7% in GI vs. 29.2% in GII, p=0.938; H/S IIc: 25% in GI vs. 25% in GII, p=1). Treatment regimes were (GI vs. GII) emergency operations 25% vs. 25% (p=1), elective operations 17.2% vs. 10% (p=0.096) and conservative treatment 57.8% vs. 64.9% (p=0.276).

Conclusion

First episodes of SD were more frequent in younger patients (≤40) and did not involve a higher risk of perforation. The indication for treatment of acute SD should not be based on age but on the severity of inflammation and the individual situation of patients.

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  1. Klinik für Allgemein-, Gefäß- und Thoraxchirurgie, Chirurgische Klinik I, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland

    C. Holmer, K.S. Lehmann, J. Gröne, H.J. Buhr & J.-P. Ritz

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  1. C. Holmer
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  2. K.S. Lehmann
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Correspondence to C. Holmer.

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Holmer, C., Lehmann, K., Gröne, J. et al. Perforationsrisiko und Patientenalter. Chirurg 82, 359–366 (2011). https://doi.org/10.1007/s00104-010-1961-z

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