Download PDF
Viszeralchirurgie 2000; 35(3): 214-218
DOI: 10.1055/s-2000-3756
ORIGINALARBEIT
© Georg Thieme Verlag Stuttgart · New York

Chirurgische Therapie der akuten Divertikulitis

Surgical therapy of acute diverticulitisC. Isbert, C.-T. Germer, H. J. Buhr
  • Chirurgische Klinik I, Abteilung für Allgemein-, Gefäß- und Thoraxchirurgie, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Berlin
Further Information

Publication History

Publication Date:
31 December 2000 (online)

    Permissions and Reprints

Zusammenfassung.

Bei der Divertikelkrankheit lassen sich 3 Verlaufsformen unterscheiden: Die asymptomatische Divertikulose, die symptomatische und die komplizierte Divertikelkrankheit. Aus prognostischen Gründen kommt fast ausschließlich die komplizierte Verlaufsform für eine chirurgische Therapie infrage. Grundlegend für die Operationsindikation und operative Verfahrenswahl sind dabei die korrekte Einschätzung und Klassifizierung der Erkrankung. Das einzeitige Vorgehen ist dabei das anzustrebende Verfahren und sollte wenn möglich elektiv erfolgen. Bei Perforation und Peritonitis sind zusätzlich aktuelle Prinzipien der Peritonitis-Therapie zu berücksichtigen.

Surgical therapy of acute diverticulitis.

Diverticular disease can be classified into asymtomatic, symptomatic or complicated. Surgery is required only for complicated disease. Indication and operative strategy is based on a correct classification and staging. Primary anastomosis is the most usefull procedure in the therapy of acute diverticular disease and should be performed electively. Perforated disease with abdominal sepsis should include basic principles of peritonitis therapy.

Schlüsselwörter:

Divertikulitis - Divertikelkrankheit - Peritonitis - Perforation

Key words:

Diverticulitis - Diverticular disease - Peritonitis - Perforation

Literatur

  • 1 Allen-Mersh T G. Should primary anastomosis and ontable colonic lavage be standard treatment for left colon emergencies?.  Proc R Coll Surg Engl. 1993;  75 195
    PubMedGoogle Scholar
  • 2 Auguste L, Borrero E, Wise L. Surgical management of perforated colonic dierticulitis.  Arch Surg. 1985;  120 (4) 450-452
    PubMedGoogle Scholar
  • 3 Belmonte C, Klas J V, Perez J J, Wong W D, Rothenberger D A, Goldberg S M, Madorff R D. The Hartmann procedure. First choice or last resort in diverticular disease?.  Arch Surg. 1996;  131 (6) 612-615
    PubMedGoogle Scholar
  • 4 Bernini A, Spencer M P, Wong W D, Rothenberger D A, Madoff R D. Computed tomography-guided percutaneous abscess drainage in intestinal disease: factors associated with outcome.  Dis Colon Rectum. 1997;  40 (9) 1009-1013
    PubMedGoogle Scholar
  • 5 Berry A R, Turner W H, Mortensen N J, Kettlewell M G. Emergency surgery for complicated diverticular disease. A five-year experience.  Dis Colon Rectum. 1989;  32 (10) 849-854
    PubMedGoogle Scholar
  • 6 Biondo S, Jaurrieta E, Jorba R, Moreno P, Farran L, Borobia F, Bettonica C, Poves I, Ramos E, Alcobendas F. Intraoperative colonic lavage and primary anastomosis in peritonitis and obstruction.  Br J Surg. 1997;  Feb, 84 (2) 222-225
    PubMedGoogle Scholar
  • 7 Buttenschön K, Buchler M, Vasilescu C, Beger H G. Change in the surgical strategy in acute and complicated colonic diverticulitis.  Chirurg. 1995;  66 (5) 487-492
    PubMedGoogle Scholar
  • 8 Eng K, Ranson J H, Localio S A. Resection of the perforated segment. A significant advance in treatment of diverticulitis with free perforation or abscess.  Am J Surg. 1977;  133 (1) 67-72
    CrossrefPubMedGoogle Scholar
  • 9 Farmakis N, Tudor R G, Keighley M R. The 5-year natural history of complicated diverticular disease.  Br J Surg. 1994;  81 (5) 733-735
    CrossrefPubMedGoogle Scholar
  • 10 Feliciano D V, Spjut-Patrinely V. Pre-, intra-, and postoperative antibiotics.  Surg Clin North Am. 1990;  70 (3) 689-701
    PubMedGoogle Scholar
  • 11 Ferzoco L B, Raptopoulos V, Silen W. Acute diverticulitis.  N Engl J Med. 1998;  338 (21) 1521-1526
    CrossrefPubMedGoogle Scholar
  • 12 Gall F. Acute diverticulitis with diffuse peritonitis - can one accept the recommendation for a single stage resection with primary anastomosis without reservation?.  Langenbecks Arch Chir. 1989;  374 (5) 257-258
    PubMedGoogle Scholar
  • 13 Graf D, Schuppisser J P, Tondelli P. Perforation of the large intestine by a contrast medium enema with barium.  Chirurg. 1988;  59 (9) 587-591
    PubMedGoogle Scholar
  • 14 Gratama S, Smedts F, Whitehead R. Obstructive colitis: an analysis of 50 cases and a review of the literature.  Pathology. 1995;  27 (4) 324-329
    PubMedGoogle Scholar
  • 15 Greif J M, Fried G, McSherry C K. Surgical treatment of perforated diverticulitis of the sigmoid colon.  Dis Colon Rectum. 1980;  23 (7) 483-487
    PubMedGoogle Scholar
  • 16 Hinchey E J, Schaal P G, Richards G K. Treatment of perforated diverticular disease of the colon.  Adv Surg. 1978;  12 85-109
    PubMedGoogle Scholar
  • 17 Hohenberger W F, Gall F P. Die Divertikelkrankheit des Dickdarmes.  Fortschr Med. 1981;  99 617
    PubMedGoogle Scholar
  • 18 Isbert C, Germer C T, Foert E, Buhr H J. Infektionen in der Chirurgie - Hohlorganperforation.  Visceralchirurgie. 1998;  33 310-315
    PubMedGoogle Scholar
  • 19 Karavias T, Hager K, Ernst M, Dollinger U. Changes in surgery of diverticulitis.  Zentralbl Chir. 1993;  118 (2) 76-80
    PubMedGoogle Scholar
  • 20 Köckerling F, Schneider C, Reymond M A, Scheidbach H, Scheuerlein H, Konradt J, Bruch H P, Zornig C, Kohler L, Barlehner E, Kuthe A, Szinicz G, Richter H A, Hohenberger W. Laparoscopic resection of sigmoid diverticulitis. Results of a multicenter study. Laparoscopic Colorectal Surgery Study Group.  Surg Endosc. 1999;  13 (6) 567-571
    CrossrefPubMedGoogle Scholar
  • 21 Kohler L, Rixen D, Troidl H. Laparoscopic colorectal resection for diverticulitis.  Int J Colorectal Dis. 1998;  13 (1) 43-47
    CrossrefPubMedGoogle Scholar
  • 22 Kohler L, Sauerland S, Neugebauer E. Diagnosis and treatment of diverticular disease: results of a consensus development conference. The Scientific Committee of the European Association for Endoscopic Surgery.  Surg Endosc. 1999;  13 (4) 430-436
    CrossrefPubMedGoogle Scholar
  • 23 Kriwanek S, Armbruster C, Beckerhinn P, Dittrich K. Prognostic factors for survival in colonic perforation.  Int J Colorectal Dis. 1994;  9(3) 158-162
    CrossrefPubMedGoogle Scholar
  • 24 Nagorney D M, Adson M A, Pemberton J H. Sigmoid diverticulitis with perforation and generalized peritonitis.  Dis Colon Rectum. 1985;  28(2) 71-75
    CrossrefPubMedGoogle Scholar
  • 25 Parks T G. The clinical significance of diverticular disease of the colon.  Practitioner. 1982;  226(1366) 643-648
    PubMedGoogle Scholar
  • 26 Roh J J, Thompson J S, Harned R K, Hodgson P E. Value of pneumoperitoneum in the diagnosis of visceral perforation.  Am J Surg. 1983;  146 (6) 830-833
    CrossrefPubMedGoogle Scholar
  • 27 Schwenk W, Hucke H P, Stock W. Postoperative complications of elective resection of the colon in diverticulitis.  Dtsch Med Wochenschr. 1992;  117 (2) 41-45
    PubMedGoogle Scholar
  • 28 Seow-Choen F, Look M C, Ho Y H. Non surgical management of colonoscopic bowel perforation.  Int J Colorectal Dis. 1995;  10(2) 77-78
    CrossrefPubMedGoogle Scholar
  • 29 Siewert J R, Huber F T, Brune I B. Early elective surgery of acute diverticulitis of the colon.  Chirurg. 1995;  66(12) 1182-1189
    PubMedGoogle Scholar
  • 30 Smirniotis V, Tsoutsos D, Fotopoulos A, Pissiotis A C. Perforated diverticulitis: a surgical dilemma.  Int Surg. 1992;  77(1) 44-47
    PubMedGoogle Scholar
  • 31 Tudor R G, Farmakis N, Keighley M R. National audit of complicated diverticular disease: analysis of index cases.  Br J Surg. 1994, May;  81(5) 730-732
    PubMedGoogle Scholar
  • 32 Tudor R G, Farmakis N, Keighley M R. National audit of complicated diverticular disease: analysis of index cases.  Br J Surg. 1994;  81(5) 730-732
    PubMedGoogle Scholar
  • 33 Vasilevsky C A, Belliveau P, Trudel J L, Stein B L, Gordon P H. Fistulas complicating diverticulitis.  Int J Colorectal Dis. 1998;  13(2) 57-60
    CrossrefPubMedGoogle Scholar
  • 34 Wedell J, Banzhaf G, Chaouri R, Fischer R, Reichmann J. Surgical management of complicated colonic diverticulitis.  Br J Surg. 1997;  84(3) 380-383
    CrossrefPubMedGoogle Scholar

Dr. med. C. Isbert

Chirurgische Klinik I
Abteilung für Allgemein-, Gefäß- und Thoraxchirurgie

Universitätsklinikum Benjamin Franklin

Freie Universität Berlin

Hindenburgdamm 30

12200 Berlin

Phone: 030 8445 2541

Fax: 030 8445 2740

Email: isbert@ukbf.fu-berlin.de

      >