Die Divertikelkrankheit des Dünndarms im Zeitalter der Dünndarmendoskopie

Zusammenfassung

Obwohl Dünndarmdivertikel mit etwa 5 % relativ häufig vorkommen, können sie als Differenzialdiagnose abdomineller Beschwerden nicht selten übersehen werden. Das mag auch damit in Zusammenhang stehen, dass erst in jüngerer Zeit eine endoskopische Untersuchung des Dünndarms mit der Kapselendoskopie und den modernen flexiblen Enteroskopieverfahren wie der Doppelballonenteroskopie oder der Singleballonenteroskopie möglich geworden ist. Jedoch rufen diese Ausstülpungen der Darmwand relevante Erkrankungsbilder hervor: Die Divertikel des Dünndarms können – ähnlich wie bei der Divertikelerkrankung des Dickdarms – Entzündungen und Abszesse, Blutungen, eine Perforation oder eine Obstruktion auslösen, und nicht selten führt eine bakterielle Fehlbesiedlung des Dünndarms zu meteoristischen Beschwerden und einer Malassimilation. Ein Meckel-Divertikel beispielsweise kann auch im jungen Erwachsenenalter durch eine rezidivierende Blutung auffallen und es stellt sich dann die Indikation zur Resektion. Hingegen ist die Indikation zur Resektion des zufällig intraoperativ entdeckten Meckel-Divertikels in der Regel nicht gegeben. Mit dem juxtapapillären Duodenaldivertikel können Komplikationen wie das Gallensteinleiden verbunden sein. Nach einem Streiflicht auf das geschichtliche Verständnis der Erkrankung, ihrer epidemiologischen Bedeutung und dem pathophysiologischen Hintergrund werden in dieser Übersichtsarbeit die diagnostischen Methoden zum Nachweis der Divertikelkrankheit des Dünndarms beleuchtet und auf die Erkrankungsbilder der primär erworbenen und der primär-kongenitalen Dünndarmdivertikel eingegangen.

Abstract

Diverticula of the small bowel are quite frequent (about 5 %), but being a differential diagnosis of abdominal complaints they may still be underdiagnosed. One reason for the low level of suspicion for a complication of small bowel diverticula might be that the small bowel was out of the gastroenterologists’ focus until recently when small bowel endoscopy became available as a reliable and practical diagnostic tool. Diverticula of the jejunum and the ileum may lead to diverticulitis, abscess, obstruction, bleeding, and perforation. Small intestinal bacterial overgrowth syndrome due to small bowel diverticula is a common complication and involves meteorism and malassimilation syndrome. Meckel’s diverticulum sometimes provokes bleeding even in the young adult and resection of the diverticulum is clearly indicated. Contrariwise, incidental detection of a Meckel’s diverticulum during abdominal laparotomy does not necessarily imply resection of the diverticulum. The juxtapapillary duodenal diverticula appear to be a risk factor for gallbladder stones, bile duct stones, and their recurrence. Moreover, the complication rate of endoscopic interventions of the bile system might be increased. In this review, we highlight the historical background of small bowel diverticular disease, present the epidemiological and pathophysiological implications and provide information on the diagnostic modalities that are available. Diseases of the primary acquired and congential small bowel diverticula are described in detail.

Schlüsselwörter

Divertikulose - Dünndarmblutung - bakterielle Fehlbesiedlung - Darm

Key words

diverticulosis - small bowel haemorrhage - bacterial overgrowth - intestines

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