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Moderne Therapie der Divertikelkrankheit

Modern therapy of diverticular disease

  • Schwerpunkt: Was ist gesichert in der Therapie?
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Zusammenfassung

Neue Konzepte finden Einzug in die Therapie der Divertikelkrankheit. Die leichte unkomplizierte Divertikulitis kann ambulant mit einem Aminosalizylat als Monotherapeutikum therapiert werden. Bei moderater Divertikulitis werden additiv oder alternativ Antibiotika verabreicht. Die schwere Divertikulitis wird stationär mittels Nulldiät, parenteraler Ernährung und i.v.-Breitbandantibiotika behandelt. Die komplizierte Divertikulitis wird interdisziplinär behandelt, größere Abszesse sollten zunächst perkutan drainiert werden, um anschließend einzeitig operiert werden zu können. Freie Perforationen bleiben eine Indikation zur Notfalloperation. Bei der rekurrierenden Divertikulitis wird die Operationsindikation nicht mehr von der Häufigkeit der Schübe, sondern vom Ausmaß der vorangegangenen Divertikulitis abhängig gemacht.

Abstract

New concepts are developed in the therapy of diverticular disease. 5-aminosalicylates can be administered in patients with slight forms of diverticulitis. In moderate diverticulitis antibiotics should be applied alternatively or additionally. In cases of severe diverticulitis patients should be kept fasting with parenteral nutrition and intravenous broad spectrum antibiotics. Small abscesses can be treated conservatively while abscesses larger than 4 cm should be drained in a first step and than treated surgically. A free perforation is still an absolute indication for emergency operation. In recurring diverticulitis indication for resection of the affected segment of the bowel should be considered depending on the extent of former attacks.

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  1. Abteilung für Innere Medizin, Evangelisches Krankenhaus Kalk, Buchforststraße 2, 51103, Köln, Deutschland

    L. Leifeld &  W. Kruis

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  1. L. Leifeld
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  2. W. Kruis
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Correspondence to L. Leifeld.

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Leifeld, L., Kruis, W. Moderne Therapie der Divertikelkrankheit. Internist 49, 1415–1420 (2008). https://doi.org/10.1007/s00108-008-2150-8

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