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Konservative Therapie der akuten Divertikulitis — Standards?

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Divertikulitis

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Zusammenfassung

Ziel der Therapiemaßnahmen bei der Divertikulitis ist, eine Notfalloperation zu vermeiden und bei Patienten mit rezidivierender oder komplizierter Divertikulitis eine elektive Intervall-OP zu ermöglichen, da dadurch die Mortalität deutlich gesenkt werden kann. Die Therapie der akuten Divertikulitis erfolgt daher bei bis zu 90% der Patienten primär konservativ. Sie stützt sich traditionell auf Maßnahmen wie Nahrungskarenz, Flüssigkeits- und Elektrolytsubstitution, symptomatische Therapie (Analgesie, Spasmolyse, lokale Kühlung), die empirische Antibiotikatherapie und die parenterale Ernährung. Allerdings stellt nur die Antibiotikatherapie bisher die einzig evidenzbasierte konservative Therapie dar. Das gewählte Antibiotikum oder deren Kombination muss breit gegen gramnegative aerobe und fakultativ sowie obligat anaerobe Bakterien wirksam sein, da häufig Mischinfektionen mit diesen Erregern vorliegen. Daneben richtet sich das individuelle Therapiekonzept aber nach dem Schweregrad der Erkrankung, wobei die Unterscheidung zwischen einfacher und komplizierter Divertikulitis im Wesentlichen auf der klinischen Diagnose beruht. In komplizierten Fällen (Abszess, Fistel, fehlende Besserung, Stenose) ist ein interventionelles Vorgehen angezeigt. Hierbei spielt die CT- oder ultraschallgesteuerte perkutane Abszessdrainage eine entscheidende Rolle. Weitere Studien sind notwendig, um den Stellenwert zusätzlicher konservativer Therapiemaßnahmen zu klären.

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Authors
  1. J. Willert
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  2. S. Hollerbach
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  3. W. H. Schmiegel
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© 2001 Springer-Verlag Berlin Heidelberg

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Willert, J., Hollerbach, S., Schmiegel, W.H. (2001). Konservative Therapie der akuten Divertikulitis — Standards?. In: Divertikulitis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-59493-9_33

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  • DOI: https://doi.org/10.1007/978-3-642-59493-9_33

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-42044-6

  • Online ISBN: 978-3-642-59493-9

  • eBook Packages: Springer Book Archive

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