Abklärung und Therapie der linksseitigen Kolondivertikulitis – Schweizer Erfahrungen

Abstract

Diagnosis and Treatment of Acute Left-Sided Colonic Diverticulitis – Swiss Experiences Left-sided colonic diverticulitis is quite common in Western societies. Until recently, the initial imaging was contrast enema with water-soluble contrast media. This test has now been replaced by computed tomography (CT: oral, rectal and intravenous contrast administration). In addition to high sensitivity of CT for the diagnosis of diverticulitis (97%), the severity of the disease can be assessed. Furthermore, CT has its role in the diagnosis and treatment of associated abscess formation, in predicting the likelihood of medical treatment failure and, finally, in predicting the risk of secondary complications after initial conservative treatment. CT is the safest and most cost-effective diagnostic test. If surgery is needed, the diseased bowel segment should be removed. The question is whether one should carry out a primary anastomosis or a Hartmann''s procedure. In our experience of over 30 years, resection with primary anastomosis can safely be performed even in advanced stages of the disease (peritonitis). Overall morbidity is high (20–30%). Anastomotic leakage occurs in 1–3%. In all operated patients the mortality rate is below 10% and in patients with mild disease below 1%. Morbidity and mortality rates are higher in Hartmann''s procedure. Therefore, resection with primary anastomosis can be recommended as the procedure of choice.