Wie bedrohlich ist eine Divertikulitis: Was wissen wir über den Langzeitverlauf?

 

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Zusammenfassung

Vor dem Hintergrund der fortbestehenden Kontroverse bezüglich der Therapiewahl bei der Kolon­divertikulitis ohne diffuse Peritonitis – konservativ oder operativ – wird eine Analyse der diesbezüg­lichen Literatur vorgenommen. Unter Berücksichtigung der Fortschritte in Diagnostik und Therapie hat in den letzten 10 Jahren ein Paradigmenwechsel für die Operationsindikation stattgefunden. Wegen des Fehlens eines Vergleichs zwischen konservativer und operativer Therapie in prospektiv-randomisierten, kontrollierten Studien müssen Fragen zur Therapie der Divertikulitis – wie Operationszeitpunkt im Stadium II a / b oder Rezidivraten speziell nach konservativer Therapie – derzeit ­offen bleiben. Die Therapiewahl sollte von der individuellen Beschwerdesymptomatik, der Komorbidität und dem Patientenalter abhängig gemacht werden. 

Abstract

In the context of the controversy regarding the appropriate management of colon diverticulitis without generalised peritonitis – conservative or operative – a review of the literature was per­formed. The progress in diagnostic and thera­peutic measures has led to a change in the therapeutic approach during the last 10 years. Because of the lack of randomised controlled trials in patients with diverticulitis (without generalised ­peritonitis) comparing medical and surgical treatments, there are still several unanswered questions, such as whether and when to operate and what the recurrence rate is, especially after medical treatment. The therapeutic management should be oriented to the individual symptoms, the comorbidity and the age of the patients.

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Prof. Dr. M. Betzler

Alfried Krupp Krankenhaus · Klinik für Allgemeine und Viszeralchirurgie · Unfall- und Gefäßchirurgie

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45131 Essen

Deutschland

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