Akute linksseitige Unterbauchschmerzen: Sonographische Differenzialdiagnose

Zusammenfassung

Akute linksseitige Unterbauchschmerzen sind, insbesondere bei älteren Patienten, häufig Folge einer Divertikulitis. Die wichtigsten Differenzialdiagnosen sind: die Nierenkolik, der Harnwegsinfekt, verschiedene gynäkologische Erkrankungen, die Nekrose einer Appendix epiploica, ein perforiertes Karzinom, andere entzündliche Erkrankungen des Darmes und pathologische Prozesse der Bauchdecke. Da mit der klinischen Untersuchung nur teilweise eine exakte Zuordnung gelingt, sind heute Schnittbildverfahren in der weiteren Diagnostik unverzichtbar. Bei akuten linksseitigen Unterbauchschmerzen sind die Sonographie und die Computertomographie die Methoden erster Wahl, sowohl für die Diagnose der Divertikulitis, als auch im Nachweis von Alternativdiagnosen oder im Falle vertebrogener Beschwerden zum Ausschluss anderer Ursachen. Aufgabe der Bildgebung ist es, eine korrekte Diagnose zu stellen und Erkrankungen, die einer akuten Intervention bedürfen von jenen zu differenzieren, die konservativ behandelt werden können. Diese Übersichtsarbeit stellt das sonographische Erscheinungsbild der wichtigsten Erkrankungen dar und verweist - soweit erforderlich - auf andere Untersuchungsmethoden.

Abstract

Acute left lower quadrant pain is frequently caused by diverticulitis, especially in elderly patients. The most common differential diagnoses include renal colic, urinary tract infection, gynaecologic disorders, epiploic appendagitis, perforated carcinoma, other inflammatory diseases of the colon and diseases of the abdominal wall. Because the clinical impression may lead to a false diagnosis, further evaluation is necessary. Imaging methods are used to establish a correct diagnosis and to differentiate between benign self-limited disorders and those which require immediate intervention. Sonography and CT are the imaging methods of choice for the examination of patients with left lower quadrant pain. Both methods have shown to be accurate in verifying diverticulitis as well as in establishing alternative diagnoses. This review reports the sonographic appearance of the different entities and refers to other imaging methods if necessary.

Schlüsselwörter

Akute Unterbauchschmerzen - Divertikulitis - Differenzialdiagnosen - Ultraschall

Key words

Acute abdominal conditions - diverticulitis - differential diagnoses - sonography

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