Der Internist

, Volume 46, Issue 6, pp 671–684 | Cite as

Divertikulose und Divertikulitis

Weiterbildung · Zertifizierte Fortbildung

Zusammenfassung

Veränderungen der Kolonwand, Motilitätsstörungen und bestimmte Ernährungsgewohnheiten sind die wesentlichen Faktoren für die Entstehung von Kolondivertikeln. Damit kommt es mit zunehmendem Alter zu einer hohen Prävalenz in westlichen Industrienationen. Klinisch besteht meist eine symptomfreie Divertikulose. Die Divertikelkrankheit kann mit geringer Symptomatik einhergehen, jedoch in komplizierten Fällen mit Divertikulitis und Divertikelblutung potenziell tödlich verlaufen. Weitere Komplikationen sind Abszessformation, Fistelbildung und Obstruktion. Die Bariumdoppelkontrastdarstellung weist zwar bei Divertikulose die höchste diagnostische Sensitivität auf, ist jedoch bei Verdacht auf eine komplizierte Divertikelkrankheit wegen der Perforationsgefahr kontraindiziert. Hier kommen Sonographie, CT oder MRT zum Einsatz. Bei Divertikelblutung bietet die Koloskopie nicht nur die Möglichkeit der Diagnostik, auch therapeutisch bietet sie verschiedene Techniken zur Blutstillung. Die Therapie der Divertikulitis und ihrer Komplikationen erfordert die sorgfältige Abwägung zwischen konservativem und operativem Vorgehen und damit eine enge interdisziplinäre Zusammenarbeit.

Schlüsselwörter

Divertikulose Divertikulitis Divertikelkrankheit Kolondivertikel Perforation 

Diverticulosis and diverticulitis

Abstract

Alterations in the colon wall, motility disorders, and certain nutritional habits are the essential factors in the development of colon diverticula. Thus, with advancing age this results in a high incidence in Western industrialized countries. The clinical picture is usually one of symptom-free diverticulosis. Diverticular disease can be associated with minor symptoms, but in complicated cases with diverticulitis and diverticular hemorrhage, it is potentially fatal. Further complications include abscess formation, fistula development, and obstruction. Barium double-contrast imaging exhibits the highest diagnostic sensitivity in diverticulosis but is contraindicated in cases of suspected complicated diverticular disease due to the danger of perforation. In these instances, sonography, computed tomography, or magnetic resonance imaging are performed. For diverticular hemorrhage, coloscopy not only represents a possible diagnostic tool but also a therapeutic option for various techniques of hemostasis. Treatment of diverticulitis and its complications requires careful consideration of conservative and surgical approaches and close interdisciplinary cooperation.

Keywords

Diverticulosis Diverticulitis Diverticular disease Colon diverticulum Perforation 

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Copyright information

© Springer Medizin Verlag 2005

Authors and Affiliations

  1. 1.Medizinische Klinik IKreiskrankenhaus Gummersbach
  2. 2.Innere AbteilungEvangelisches Krankenhaus Köln-Kalk
  3. 3.Medizinische Klinik IKreiskrankenhaus GummersbachGummersbach

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