Akute Divertikulitis des Colon descendens – sonografische Diagnose

Zusammenfassung

Auf der Grundlage einer Kasuistik werden in dieser Übersicht typische sonografische Befunde und Untersuchungstechnik bei akuter Divertikulitis des Kolon dargestellt. Der Stellenwert der abdominellen Sonografie wird im Vergleich zu anderen bildgebenden Verfahren diskutiert. Die neue deutsche S2k-Leitlinie zur Divertikelkrankheit und Divertikulitis räumt der abdominellen Sonografie mit Recht eine herausgehobene Bedeutung als Methode der ersten Wahl für Diagnose und Verlaufsbeurteilung der akuten Divertikulitis ein.

Abstract

Based on a case study this review describes typical sonographic findings and appropriate examination technique in acute colonic diverticulitis. The diagnostic value of abdominal ultrasonography is discussed in comparison with other imaging techniques. The new German S2k guidelines on diverticular disease and diverticulitis rightly characterize abdominal ultrasonography as first-line imaging modality for the initial diagnostic workup and follow-up of acute diverticulitis.

Schlüsselwörter

akute Divertikulitis - Abdomensonografie - Bildgebung - Diagnostik - Leitlinie

Key words

acute colonic diverticulitis - abdominal ultrasonography - imaging - diagnostics - guidelines

• Literatur

• 1 Leifeld L, Germer CT, Bohm S et al. S2k Leitlinie Divertikelkrankheit/Divertikulitis. Z Gastroenterol 2014; 52: 663-710
• 2 Jun S, Stollman N. Epidemiology of diverticular disease. Best Pract Res Clin Gastroenterol 2002; 16: 529-542
• 3 Delvaux M. Diverticular disease of the colon in Europe: epidemiology, impact on citizen health and prevention. Aliment Pharmacol Ther 2003; 18 (Suppl. 03) 71-74
• 4 Commane DM, Arasaradnam RP, Mills S et al. Diet, ageing and genetic factors in the pathogenesis of diverticular disease. World J Gastroenterol 2009; 15: 2479-2488
• 5 Strate LL, Modi R, Cohen E et al. Diverticular disease as a chronic illness: evolving epidemiologic and clinical insights. Am J Gastroenterol 2012; 107: 1486-1493
• 6 Shahedi K, Fuller G, Bolus R et al. Long-term risk of acute diverticulitis among patients with incidental diverticulosis found during colonoscopy. Clin Gastroenterol Hepatol 2013; 11: 1609-1613
• 7 Kvasnovsky CL, Papagrigoriadis S, Bjarnason I. Increased diverticular complications with nonsteriodal anti-inflammatory drugs and other medications: a systematic review and meta-analysis. Colorectal Dis 2014; 16: O189-O196
• 8 Strate LL, Liu YL, Huang ES et al. Use of aspirin or nonsteroidal anti-inflammatory drugs increases risk for diverticulitis and diverticular bleeding. Gastroenterology 2011; 140: 1427-1433
• 9 Yuhara H, Corley DA, Nakahara F et al. Aspirin and non-aspirin NSAIDs increase risk of colonic diverticular bleeding: a systematic review and meta-analysis. J Gastroenterol 2014; 49: 992-1000
• 10 Cologne KG, Skiada D, Beale E et al. Effects of diabetes mellitus in patients presenting with diverticulitis: clinical correlations and disease characteristics in more than 1000 patients. J Trauma Acute Care Surg 2014; 76: 704-709
• 11 Etzioni DA, Mack TM, Beart Jr RW et al. Diverticulitis in the United States: 1998–2005: changing patterns of disease and treatment. Ann Surg 2009; 249: 210-217
• 12 Jamal Talabani A, Lydersen S, Endreseth BH et al. Major increase in admission- and incidence rates of acute colonic diverticulitis. Int J Colorectal Dis 2014; 29: 937-945
• 13 Wheat CL, Strate LL. Trends in Hospitalization for Diverticulitis and Diverticular Bleeding in the United States From 2000 to 2010. Clin Gastroenterol Hepatol 2015; 13 : Apr 8 [Epub ahead of print]
• 14 Binda GA, Arezzo A, Serventi A et al. Multicentre observational study of the natural history of left-sided acute diverticulitis. Br J Surg 2012; 99: 276-285
• 15 Hollerweger A, Macheiner P, Gritzmann N. Akute linksseitige Unterbauchschmerzen: Sonographische Differenzialdiagnose. Ultraschall in Med 2003; 24: 7-16
• 16 Hwang JA, Kim SM, Song HJ et al. Differential diagnosis of left-sided abdominal pain: primary epiploic appendagitis vs colonic diverticulitis. World J Gastroenterol 2013; 19: 6842-6848
• 17 Laurell H, Hansson LE, Gunnarsson U. Acute diverticulitis – clinical presentation and differential diagnostics. Colorectal Dis 2007; 9: 496-501 ; discussion 501–492
• 18 Mauch M, Seitz K. Divertikulitis. Ultraschall in Med 2007; 28: 346-365 ; quiz 366–371
• 19 Dietrich CF, Lembcke B, Jenssen C et al. Intestinal ultrasound in rare gastrointestinal diseases, update, part 1. Ultraschall in Med 2014; 35: 400-421
• 20 Dietrich CF, Lembcke B, Jenssen C et al. Intestinal Ultrasound in Rare Gastrointestinal Diseases, Update, Part 2. Ultraschall in Med 2015; 36 : Jun 19 [Epub ahead of print]
• 21 Gritzmann N, Hollerweger A, Macheiner P et al. Transabdominal sonography of the gastrointestinal tract. Eur Radiol 2002; 12: 1748-1761
• 22 Andeweg CS, Wegdam JA, Groenewoud J et al. Toward an evidence-based step-up approach in diagnosing diverticulitis. Scand J Gastroenterol 2014; 49: 775-784
• 23 Toorenvliet BR, Bakker RF, Breslau PJ et al. Colonic diverticulitis: a prospective analysis of diagnostic accuracy and clinical decision-making. Colorectal Dis 2010; 12: 179-186
• 24 Lameris W, van Randen A, van Gulik TM et al. A clinical decision rule to establish the diagnosis of acute diverticulitis at the emergency department. Dis Colon Rectum 2010; 53: 896-904
• 25 Zielke A, Hasse C, Nies C et al. Prospective evaluation of ultrasonography in acute colonic diverticulitis. Br J Surg 1997; 84: 385-388
• 26 Hollerweger A, Macheiner P, Rettenbacher T et al. Colonic diverticulitis: diagnostic value and appearance of inflamed diverticula-sonographic evaluation. Eur Radiol 2001; 11: 1956-1963
• 27 Seitz K. Sonographische Divertikulitisdiagnostik: Der mühsame Weg zur Akzeptanz. Ultraschall in Med 2004; 25: 335-336
• 28 Vijayaraghavan SB. High-resolution sonographic spectrum of diverticulosis, diverticulitis, and their complications. J Ultrasound Med 2006; 25: 75-85
• 29 Valentino M, Serra C, Ansaloni L et al. Sonographic features of acute colonic diverticulitis. J Clin Ultrasound 2009; 37: 457-463
• 30 Puylaert JB. Ultrasound of colon diverticulitis. Dig Dis 2012; 30: 56-59
• 31 Helou N, Abdalkader M, Abu-Rustum RS. Sonography: first-line modality in the diagnosis of acute colonic diverticulitis?. J Ultrasound Med 2013; 32: 1689-1694
• 32 Lembcke BJ, Strobel D, Dirks K et al. Statement of the section internal medicine of the DEGUM – ultrasound obtains pole position for clinical imaging in acute diverticulitis. Ultraschall in Med 2015; 36: 191-195
• 33 Parulekar SG. Sonography of colonic diverticulitis. J Ultrasound Med 1985; 4: 659-666
• 34 Verbanck J, Lambrecht S, Rutgeerts L et al. Can sonography diagnose acute colonic diverticulitis in patients with acute intestinal inflammation? A prospective study. J Clin Ultrasound 1989; 17: 661-666
• 35 Wilson SR, Toi A. The value of sonography in the diagnosis of acute diverticulitis of the colon. Am J Roentgenol 1990; 154: 1199-1202
• 36 Schwerk WB, Schwarz S, Rothmund M. Sonography in acute colonic diverticulitis. A prospective study. Dis Colon Rectum 1992; 35: 1077-1084
• 37 Schwerk WB, Schwarz S, Rothmund M et al. Kolondivertikulitis: Bildgebende Diagnostik mit Ultraschall - Eine prospektive Untersuchung. Z Gastroenterol 1993; 31: 294-300
• 38 Pradel JA, Adell JF, Taourel P et al. Acute colonic diverticulitis: prospective comparative evaluation with US and CT. Radiology 1997; 205: 503-512
• 39 Zielke A, Hasse C, Bandorski T et al. Diagnostic ultrasound of acute colonic diverticulitis by surgical residents. Surg Endosc 1997; 11: 1194-1197
• 40 Hollerweger A, Rettenbacher T, Macheiner P et al. Sigmoid diverticulitis: value of transrectal sonography in addition to transabdominal sonography. Am J Roentgenol 2000; 175: 1155-1160
• 41 Moll R, Mittelkotter U, Reith HB et al. Welche bildgebende Diagnostik bei Verdacht auf eine Sigmadivertikulitis? Wertigkeit der sonographischen Untersuchungsverfahren (konventionelle B-Bild-Diagnostik in Kombination mit der Hydrokolonsonographie und der farbkodierten Duplexsonographie) im Vergleich mit den etablierten Verfahren wie dem Kolon-Kontrasteinlauf und der Spiral-Computertomographie. Zentralbl Chir 2002; 127: 297-301
• 42 Ripolles T, Agramunt M, Martinez MJ et al. The role of ultrasound in the diagnosis, management and evolutive prognosis of acute left-sided colonic diverticulitis: a review of 208 patients. Eur Radiol 2003; 13: 2587-2595
• 43 Farag Soliman M, Wustner M, Sturm J et al. Primärdiagnostik der akuten Sigmadivertikulitis . Sonografie versus Computertomografie, eine prospektive Studie. Ultraschall in Med 2004; 25: 342-347
• 44 Liljegren G, Chabok A, Wickbom M et al. Acute colonic diverticulitis: a systematic review of diagnostic accuracy. Colorectal Dis 2007; 9: 480-488
• 45 Lameris W, van Randen A, Bipat S et al. Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy. Eur Radiol 2008; 18: 2498-2511
• 46 van Randen A, Lameris W, van Es HW et al. A comparison of the accuracy of ultrasound and computed tomography in common diagnoses causing acute abdominal pain. Eur Radiol 2011; 21: 1535-1545
• 47 King WC, Shuaib W, Vijayasarathi A et al. Benefits of sonography in diagnosing suspected uncomplicated acute diverticulitis. J Ultrasound Med 2015; 34: 53-58
• 48 Brenner DJ, Hall EJ. Computed tomography – an increasing source of radiation exposure. N Engl J Med 2007; 357: 2277-2284
• 49 Fazel R, Krumholz HM, Wang Y et al. Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med 2009; 361: 849-857
• 50 Berrington de Gonzalez A, Mahesh M, Kim KP et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med 2009; 169: 2071-2077
• 51 Kaiser AM, Jiang JK, Lake JP et al. The management of complicated diverticulitis and the role of computed tomography. Am J Gastroenterol 2005; 100: 910-917
• 52 Andeweg CS, Mulder IM, Felt-Bersma RJ et al. Guidelines of diagnostics and treatment of acute left-sided colonic diverticulitis. Dig Surg 2013; 30: 278-292
• 53 Hansen O, Graupe F, Stock W. Diagnosis of diverticulitis in routine practice: progress due to pelvic CT?. Langenbecks Arch Chir Suppl Kongressbd 1998; 115: 170-173
• 54 Nielsen K, Richir MC, Stolk TT et al. The limited role of ultrasound in the diagnostic process of colonic diverticulitis. World J Surg 2014; 38: 1814-1818
• 55 Sartelli M, Moore FA, Ansaloni L et al. A proposal for a CT driven classification of left colon acute diverticulitis. World J Emerg Surg 2015; 10: 3
• 56 Gielens MP, Mulder IM, van der Harst E et al. Preoperative staging of perforated diverticulitis by computed tomography scanning. Tech Coloproctol 2012; 16: 363-368
• 57 Ritz JP, Lehmann KS, Loddenkemper C et al. Preoperative CT staging in sigmoid diverticulitis – does it correlate with intraoperative and histological findings?. Langenbecks Arch Surg 2010; 395: 1009-1015
• 58 Werner A, Diehl SJ, Farag-Soliman M et al. Multi-slice spiral CT in routine diagnosis of suspected acute left-sided colonic diverticulitis: a prospective study of 120 patients. Eur Radiol 2003; 13: 2596-2603
• 59 Schiller VL, Schreiber L, Seaton C et al. Transvaginal sonographic diagnosis of sigmoid diverticulitis. Abdom Imaging 1995; 20: 253-255
• 60 Broekman BA, Puylaert JB, van Dessel T. Sigmoid diverticulitis in the female: transvaginal sonographic findings. J Clin Ultrasound 1993; 21: 393-395
• 61 Ambrosetti P, Robert J, Witzig JA et al. Prognostic factors from computed tomography in acute left colonic diverticulitis. Br J Surg 1992; 79: 117-119
• 62 Ambrosetti P, Grossholz M, Becker C et al. Computed tomography in acute left colonic diverticulitis. Br J Surg 1997; 84: 532-534
• 63 Rao PM, Rhea JT, Novelline RA et al. Helical CT with only colonic contrast material for diagnosing diverticulitis: prospective evaluation of 150 patients. Am J Roentgenol 1998; 170: 1445-1449
• 64 Ambrosetti P, Jenny A, Becker C et al. Acute left colonic diverticulitis--compared performance of computed tomography and water-soluble contrast enema: prospective evaluation of 420 patients. Dis Colon Rectum 2000; 43: 1363-1367
• 65 Ambrosetti P, Becker C, Terrier F. Colonic diverticulitis: impact of imaging on surgical management – a prospective study of 542 patients. Eur Radiol 2002; 12: 1145-1149
• 66 Lameris W, van Randen A, van Es HW et al. Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. BMJ 2009; 338: b2431
• 67 Stoker J, van Randen A, Lameris W et al. Imaging patients with acute abdominal pain. Radiology 2009; 253: 31-46
• 68 van Randen A, Lameris W, Nio CY et al. Inter-observer agreement for abdominal CT in unselected patients with acute abdominal pain. Eur Radiol 2009; 19: 1394-1407
• 69 Ambrosetti P. Value of CT for acute left-colonic diverticulitis: the surgeon's view. Dig Dis 2012; 30: 51-55
• 70 Schreyer AG, Menzel C, Friedrich C et al. Comparison of high-resolution ultrasound and MR-enterography in patients with inflammatory bowel disease. World J Gastroenterol 2011; 17: 1018-1025
• 71 Schreyer AG, Layer G. S2k Guidlines for Diverticular Disease and Diverticulitis: Diagnosis, Classification, and Therapy for the Radiologist. Fortschr Röntgenstr 2015; 187: 676-684
• 72 Heverhagen JT, Ishaque N, Zielke A et al. Feasibility of MRI in the diagnosis of acute diverticulitis: initial results. MAGMA 2001; 12: 4-9
• 73 Heverhagen JT, Zielke A, Ishaque N et al. Acute colonic diverticulitis: visualization in magnetic resonance imaging. Magn Reson Imaging 2001; 19: 1275-1277
• 74 Takada T, Nakagawa S, Hashimoto K et al. Preoperative diagnosis of colouterine fistula secondary to diverticulitis by sonohysterography with contrast medium. Ultrasound Obstet Gynecol 2004; 24: 682-683
• 75 Girlich C, Schacherer D, Lamby P et al. Innovations in contrast enhanced high resolution ultrasound improve sonographic imaging of the intestine. Clin Hemorheol Microcirc 2010; 45: 207-215
• 76 Ignee A, Jenssen C, Cui XW et al. Intracavitary contrast-enhanced ultrasound in abscess drainage – feasibility and clinical value. Scand J Gastroenterol 2015; 50 : July 11, 1–7 (Epub ahead of print)
• 77 Klarenbeek BR, de Korte N, van der Peet DL et al. Review of current classifications for diverticular disease and a translation into clinical practice. Int J Colorectal Dis 2012; 27: 207-214