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Die Koinzidenz von Kolonadenomen und Kolonkarzinomen bei der Divertikulitis

The coincidence of adenomas and carcinomas of the colon in diverticular disease

  • Published:
Coloproctology Aims and scope

Zusammenfassung

Von Januar 1987 bis Januar 1996 wurden an der Klinik für Chirurgie der Medizinischen Universität zu Lübeck 267 Patienten mit einer Divertikelkrankheit des Kolons stationär behandelt: 178 Patienten (66,7%) wurden operiert, 89 Patienten (33,3%) wurden konservativ therapiert.

Bei 18 Patienten (6,7%) — neun operiete sowie neun konservativ behandelte — fanden sich sowohl benigne als auch maligne Zusatzbefunde: Bei 15 Patienten (5,6%) wurden 19 koloreiktale Adenome mit gering-bis mittelgradigen Epitheldysplasien festgestellt, wobei in mehr als einem Drittel der Fälle die Adenome proximal der Divertikelzone lokalisiert waren. Maligne bzw. semimaligne Zusatzbefunde wurden bei drei Patienten diagnostiziert: zwei Sigmakarzinome (0,7%) sowie ein Karzinoid der Appendix (0,4%). Alle drei Patienten wurden kurativ ohne Notwendigkeit eines Folgeeingriffs nach onkologischen Kriterien operiert.

Die mögliche Koinzidenz von benignen und malignen Kolontumoren bei der Divertikulitis macht eine umfassende Diagnostik (Kolonkontrasteinlauf, Computertomographie, Koloskopie) notwendig. Der Stellenwert der totalen Koloskopie zum Ausschluß einer Kolonneoplasie bleibt unangefochten. Gleichzeitig ist bei unklaren, malignitätsverdächtigen Befunden (zum Beispiel Sigmastenose) die Indikation zur onkologischen Operation gegeben.

Abstract

Between January 1987 and January 1996 267 patients were treated for diverticular disease of the colon at the Department of Surgery of the Medical University of Luebeck. Hundred and seventy-eight patients (66.7%) underwent surgery, 89 patients (33.3%) were treated conservatively by bowel rest and intravenous antibiotics.

In 18 patients (6.7%) — 9 who underwent surgery and 9 who were treated by medical therapy — diagnostic evaluation or surgery itself revealed both benign and malignant coexisting lesions. In 15 patients (5.6%) 19 colorectal adenomas were found, whereas the adenomas were located proximal to the diverticular zone in more than a third of the cases. Coincidence of malignant or semimalignant pathology was assessed in 3 patients: 2 sigmoid carcinomas (0.7%) and 1 carcinoid of the appendix (0.4%). Radical resections following oncological principles were carried out in all 3 patients.

The possible coincidence of benign or malignant colorectal tumors in patients with diverticular disease renders the necessity of exact diagnostic evaluation including water-soluable contrast enema, CT scan and endoscopy. Particularly, total colonoscopy to detect coexisting colonic neoplasms has to be recommended. Moreover, uncertain differentiation from cancer or suspect diverticulitis suspicious of malignancy (e. g. sigmoid stenosis) refers to the indication for oncological surgery.

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  1. Klinik für Chirurgie, Medizinische Universität, Ratzeburger Allee 160, D-23538, Lübeck

    Oliver Schwandner & Hans-Peter Bruch

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Schwandner, O., Schiedeck, T.H.K., Gleiß, J. et al. Die Koinzidenz von Kolonadenomen und Kolonkarzinomen bei der Divertikulitis. Coloproctol 20, 90–98 (1998). https://doi.org/10.1007/BF03043798

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