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Amodu LI, Boyd BA, Smirnov V. Jejunal Diverticulosis Causing Small Intestinal Volvulus and Closed Loop Obstruction. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e943376. [PMID: 38693681 DOI: 10.12659/ajcr.943376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
BACKGROUND Jejunal diverticulosis are false diverticula of the small bowel that form from outpouching of the mucosa and submucosa. They are pulsion diverticula that are often asymptomatic and can be found incidentally during surgery. In some instances, jejunal diverticula could result in intestinal obstruction. Small intestinal volvulus is an uncommon cause of small bowel obstruction that results in a closed loop obstruction and is an indication for emergent surgical intervention. CASE REPORT We report a case of an 84-year-old man who presented to the Emergency Department with abdominal pain and generalized weakness. A preoperative computerized tomographic scan demonstrated a closed loop small bowel obstruction with mesenteric swirling. The patient was taken for a diagnostic laparoscopy, which revealed extensive proximal jejunal diverticulosis and a volvulus of the involved jejunum. An exploratory laparotomy was warranted for safe detorsion of the small bowel and resection of the diseased segment. The small bowel was successfully detorsed, with resection of the involved jejunum. Intestinal continuity was established by a primary side-to-side anastomosis. CONCLUSIONS Jejunal diverticula have been reported in the literature as a cause of small bowel obstructions, and very few reports exist of concurrent small bowel volvulus. In very rare instances, both of these conditions can coexist. There should be prompt surgical intervention in all cases of closed loop small bowel obstructions to prevent intestinal ischemia, perforation, and sepsis.
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Dagnesses Fonseca JO, Danes Grases JE, Luengo Batres P, Calvo Espino P. Digestive bleeding due to jejunal diverticula: diagnosis and management. BMJ Case Rep 2024; 17:e259089. [PMID: 38688577 PMCID: PMC11085889 DOI: 10.1136/bcr-2023-259089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
A jejunal diverticular haemorrhage is the second most common complication of jejunum diverticula. It can manifest clinically as acute upper gastrointestinal bleeding and is common to imitate acute rectal bleeding. Bleeding is usually associated with or without haemodynamic stability. Its diagnosis is challenging, requiring imaging examinations. Treatment is conservative management or surgery.
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Grudzińska E, Mrowiec S, Pilch-Kowalczyk J, Ciupińska M, Kusnierz K. Small Intestinal Intussusception Due to Complicated Giant Jejunal Diverticulosis. ACTA ACUST UNITED AC 2021; 57:medicina57020116. [PMID: 33525341 PMCID: PMC7910828 DOI: 10.3390/medicina57020116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 01/04/2023]
Abstract
Background: Jejunal diverticulosis and jejunal lipomatosis are uncommon conditions. Usually asymptomatic, they may cause severe complications in some cases. Intussusception is unusual in adults, but when diagnosed swiftly it can be treated surgically, usually with good outcome. Case presentation: We present a 60-year-old female patient with a history of chronic malnutrition and anemia, complaining of acute abdominal pain, vomiting and diarrhea. Contrast-enhanced abdominal computed tomography (CT) showed intussusception, multiple giant jejunal diverticula and multiple lipomas. The patient underwent urgent surgery, but radical treatment was not possible due to the extent of the diseases. One month later, another surgery was needed due to ileostomy obstruction caused by lipomas. The patient’s condition deteriorated due to malnutrition and concomitant metabolic disorders, which eventually led to her demise. Conclusions: Radical treatment is not always possible in an extensive jejunal disease. Prolonged malnutrition impairs postoperative healing, and therefore surgical or nutritional treatment should be considered in jejunal diverticulosis before the onset of severe complications requiring urgent surgical intervention.
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Relvas-Silva M, Pinho AR, Vital L, Leão B, Sousa AN, Carvalho AC, Veludo V. Azole-resistant Candida albicans Spondylodiscitis After Bariatric Surgery: A Case Report. JBJS Case Connect 2020; 10:e1900618. [PMID: 32773714 DOI: 10.2106/jbjs.cc.19.00618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CASE We present a case of azole and partial caspofungin-resistant Candida albicans spondylodiscitis, after bariatric surgery with bowel perforation. Treatment included debridement and several months of anidulafungin, complemented with antibacterial therapy because of relapse for bacterial superinfection. After treatment, the infection did not recur clinically or radiologically during one and half years follow-up. CONCLUSION Although C. albicans spondylodiscitis is rare, fungi should be suspected as a causative agent. Adequate history, imaging and laboratory testing, and medical and surgical treatment should be performed to successfully eradicate the infection and resolve potential neurological deficits.
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Blanco Velasco G, Pérez Rodríguez M, Álvarez Licona NE. Small bowel transit time of capsule endoscopy as a factor for the detection of lesions in potential small bowel bleeding. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:696-698. [PMID: 31333041 DOI: 10.17235/reed.2019.5943/2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND the relationship between small bowel transit time (SBTT) of the capsule endoscopy (CE) and the diagnosis of small bowel bleeding (SBB) is controversial. OBJECTIVE to evaluate the relationship between SBTT and CE and the identification of SBB. MATERIAL AND METHODS CE was divided according to SBTT into < 4 hours and ≥ 4 hours. RESULTS CE with SBTT ≥ 4 hours identified more angioectasias (p = 0.023), single lesions (p = 0.029) and jejunal lesions (p = 0.001) with an OR of 3.13 (95% CI, 1.61-6.10, p = 0.001) to identify the cause of SBB. CONCLUSIONS CE SBTT of ≥ 4 hours increases the diagnosis of SBB.
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Vega L, Carmona D, Camps J. Regarding a case of perforated jejunal diverticulitis. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2019; 84:515-516. [PMID: 31227414 DOI: 10.1016/j.rgmx.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/21/2019] [Accepted: 04/03/2019] [Indexed: 11/19/2022]
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Viscosi F, Pintabona G, Foti A, Cucinotta E, Mazzeo C. Therapeutic strategies for perforated jejunal diverticulitis. A case report. Ann Ital Chir 2019; 8:S2239253X1903072X. [PMID: 31112519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIM The jejuno-ileal diverticulosis is an unusual disease which affects elderly people and its complications can be fatal due to delayed diagnosis. The most frequent complication of jejunal diverticulitis is the perforation. CASE REPORT In this report we describe a case of elderly patient presenting with acute abdominal pain and fever. The patient underwent to an urgent exploratory laparotomy that revealed a perforated small bowel diverticulum. An intestinal resection with primary anastomosis was performed. DISCUSSION Jejunal diverticulosis often presents with non-specific symptoms like intermittent abdominal pain, dyspepsia, bloating or abdominal fullness and constipation. When, instead, it incurs a complication, it presents with an acute abdominal pain. The most frequent complication of jejunal diverticulitis is the perforation, followed by acute intestinal obstruction and diverticular bleeding. The diverticular perforation is associated with a high mortality, especially among elderly patients. Nowadays the mortality is reduced because of the improvement of the diagnostic, pharmaceutical and surgical protocols. CONCLUSIONS With this report we want to discuss about different therapeutic approaches for perforated jejuno-ileal diverticula, which depends on the severity of the disease and the general clinical condition of the patient. KEY WORDS Acute abdomen, Surgery, Jejunal Diverticulitis.
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Lebert P, Ernst O, Zins M. Acquired diverticular disease of the jejunum and ileum: imaging features and pitfalls. Abdom Radiol (NY) 2019; 44:1734-1743. [PMID: 30758535 DOI: 10.1007/s00261-019-01928-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To present radiological aspects of jejunoileal diverticulosis and its complications. RESULTS Jejunoileal diverticulosis is a relatively rare and underestimated condition, which mostly affects the elderly. It is frequently asymptomatic but it can lead to significant complications requiring surgical treatment. Jejunoileal diverticulosis is far less common than colonic diverticulosis. Acquired small bowel diverticula are often numerous but the complication rate is low. Acute diverticulitis is the most frequent complication; its classic presentation involves the jejunum and is often non-severe. Diverticular hemorrhage is the second most common complication; CT scan examination is essential to determine the accurate topography of the pathological diverticula. Small bowel obstruction can occur through several mechanisms: adhesions, enterolith, and intussusception. Extra-intestinal gas without perforation and "pseudo-ischemic" appearance are non-pathological conditions that are important to diagnose in order to avoid surgery. CONCLUSION Jejunoileal diverticulosis usually does not show any symptoms but can lead to diagnostic challenges requiring evaluation by CT. CT scan signs of these complications and some pitfalls must be known.
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Cedrón H, Valenzuela V, Aliaga Ramos JJ, Cáceres J. [Jejunal phlebectasia as a cause of massive gastrointestinal haemorrhage]. REVISTA DE GASTROENTEROLOGIA DEL PERU : ORGANO OFICIAL DE LA SOCIEDAD DE GASTROENTEROLOGIA DEL PERU 2019; 39:84-87. [PMID: 31042243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Vascular abnormalities of the gastrointestinal tract are a common cause of gastrointestinal bleeding. Most of them are located within the reach of the upper endoscopy or colonoscopy, although once discarded, it forces to consider small bowel as the source of bleeding. The successful management of a gastrointestinal bleeding depends mainly on the timely location of the source of bleeding. Nevertheless this task can be difficult when the cause is not within the reach of conventional methods. We present a case of a 21 year-old men in which the diagnosis of bleeding yeyunal phlebectasia was made by the findings of the capsule endoscopy and laparoscopy.
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Shiratori Y, Fukuda K, Ikeya T, Takagi K, Nakamura K. Primary gastrointestinal amyloidosis with gastrointestinal hemorrhage and intestinal pseudo-obstruction: a report of a rare case. Clin J Gastroenterol 2018; 12:258-262. [PMID: 30574660 PMCID: PMC6542774 DOI: 10.1007/s12328-018-00929-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 12/11/2018] [Indexed: 11/26/2022]
Abstract
Amyloidosis is a syndrome involving amyloid protein deposition in various organs, resulting in organ dysfunction. Symptoms of gastrointestinal amyloidosis are usually nonspecific, such as diarrhea and body weight loss. We, here, report a patient who presented to the hospital with simultaneous hematemesis, melena, and intestinal pseudo-obstruction, leading to a diagnosis of primary gastrointestinal amyloidosis based on computed tomography (CT) and endoscopic findings. CT showed diffuse wall thickening from the duodenum to the jejunum, jejunal dilation, and fluid accumulation throughout the gastrointestinal tract. Upper gastrointestinal endoscopy revealed duodenal mucosal edema, jejunal dilation, and small hemorrhages from jejunal mucosal erosion. The definite diagnosis was done based on biopsy results. This report describes the early diagnosis of gastrointestinal amyloidosis based on CT and endoscopy findings.
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Minafra M, Laforgia R, Riccelli U, Volpi A, Punzo C, Carbotta G, Pisicchio S, Papagni V, Panebianco A, Palasciano N. Complicated duodenal-jejunal diverticulosis: case report. G Chir 2018; 39:395-398. [PMID: 30563606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Bleedings such as melaena are related to diseases in the upper gastrointestinal tract. In 0.06% - 5% of cases these incidents are due to the presence of diverticula of the small intestine, which are asymptomatic and unrecognized in most patients and are only fully diagnosed in cases when complications occur. CASE REPORT An 88-year old male patient presented with severe anaemia, asthenia and melaena in the previous days. An esophagogastroduodenoscopy (EGDS) was performed with evidence of stenosis in the second part of the duodenum and a blood clot in the posterior wall without signs of active bleeding. A complete CT scan was carried out of the thorax, abdomen and pelvis using a contrast medium, which revealed a dilation of the stomach and of the first part of the duodenum with a diverticulum of the second. On the fourth day following admission the patient suffered a haemorrhagic shock and underwent an emergency surgical procedure with a bleeding diverticulum on the posterior wall of the duodenum tightly adhering to the pancreas being found. Therefore an atypical duodenal-jejunal resection was performed using a gastrojejunal Roux-en-Y bypass and the closure of the duodenal stump. CONCLUSION Diverticulosis of the duodenum and small intestine is considered a rare disease. According to the literature, treatment should be conservative, and surgical options considered only in those very rare cases of complicated and life-threatening diverticulosis.
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Ceuppens AS, Dhont S, Sneyers B, Schepers C, Ramboer K, Van Hootegem P. Jejuno-ileal diverticulosis : a review of literature. Acta Gastroenterol Belg 2018; 81:517-519. [PMID: 30645921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Jejunal diverticulosis is a rare entity with variable clinical and anatomical presentations. The majority of cases are discovered incidentally during radiological investigations. Based on a case of a 77 year old woman with jejunal diverticulitis, the current literature about small bowel diverticulosis is reviewed. A jejunoileal diverticulum is usually uncomplicated and can be treated conservatively. Serious complications that require surgery can occur. Abdominal CT is the preferred diagnostic tool.
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Kalliakmanis V, Perysinakis I, Koutsouvas K, Karras P, Margaris E, Angelakis C. Massive intussusception caused by a solitary Peutz-Jeghers type hamartomatous polyp. Ann R Coll Surg Engl 2018; 100:e91-e93. [PMID: 29484932 PMCID: PMC5958860 DOI: 10.1308/rcsann.2018.0019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 02/01/2023] Open
Abstract
Intussusception is a rare cause of intestinal obstruction in adults and represents a diagnostic challenge for the surgeon. In the majority of cases, presenting symptoms are not specific, making preoperative diagnosis difficult. Several medical conditions may cause intestinal intussusception. We present the case of a 16-year-old female patient with intussusception due to a hamartomatous Peutz-Jeghers type polyp. This is an extremely rare case in which the first manifestation of the intestinal polyp was jejunojejunal intussusception very close to the duodenojejunal junction, with a necrotic intussusceptum about 50 cm long. The patient was treated successfully with enterectomy and end-to-end anastomosis. Postoperative course was uneventful and the patient is currently under gastroenterological and genetic investigation to exclude the diagnosis of Peutz-Jeghers syndrome.
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Gravito-Soares M, Gravito-Soares E, Figueiredo P. An uncommon cause of overt small bowel bleeding. Acta Gastroenterol Belg 2018; 81:349. [PMID: 30024716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Falckenheiner Soria J, Bernal Moreno D, Flores Rivera JM, Toro Guillen M, Lérida Vaca JL. Heterotopic Pancreas. Intestinal Obstruction Caused by a Yeyunal Intussuception. Cir Esp 2017; 96:237-239. [PMID: 29103610 DOI: 10.1016/j.ciresp.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 08/15/2017] [Accepted: 09/05/2017] [Indexed: 02/07/2023]
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Li J, Huang H, Huo S, Liu Y, Xu G, Gao H, Zhang K, Liu T. Ectopic pancreatic tissue in the wall of the small intestine: Two rare case reports. Medicine (Baltimore) 2017; 96:e7986. [PMID: 28858137 PMCID: PMC5585531 DOI: 10.1097/md.0000000000007986] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Ectopic pancreas, which is a kind of rare congenital disease, forms during embryonic development. It can occur throughout the whole gastrointestinal tract, but has a low tendency to develop in the wall of the small intestine. It is easy for patients with ectopic pancreases to be misdiagnosed because the symptoms are untypical and can vary. PATIENT CONCERNS In the present study, we reported two rare cases of ectopic pancreatic tissue in the wall of the small intestine, which presented with obvious abdominal pain and distention. DIAGNOSIS The laboratory tests and computed tomography (CT) scans didn't reveal any evidence of ectopic pancreas. INTERVENTIONS The two patients received small intestine masses resection and intestinal anastomosis. OUTCOMES During surgery, an intestinal mass with a diameter of 4.0 cm was found in the first patient. An intestinal mass with a diameter of 0.8 cm, jejunum perforation, and diffuse peritonitis were found in the second patient. Histological analyses of the dissected intestinal masses confirmed them as ectopic pancreatic tissue. Interestingly, for the second patient, the intestinal perforation and diffuse peritonitis were not induced by the ectopic pancreas, but by a jujube pit that was found in the perforated site of the intestine. LESSONS Our study demonstrated that an ectopic pancreas should be considered in cases of untypical abdominal symptoms with intestinal masses.
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López Marcano AJ, Ramia JM, De la Plaza Llamas R, Alonso S, Gonzales Aguilar JD, Kühnhardt Barrantes AW. [Complicated jejunoileal diverticular disease: a 12 cases' serie and literature review]. REVISTA DE GASTROENTEROLOGIA DEL PERU : ORGANO OFICIAL DE LA SOCIEDAD DE GASTROENTEROLOGIA DEL PERU 2017; 37:240-245. [PMID: 29093588 DOI: pmid/29093588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To perform a retrospective analysis of a series of complicated JID (jejunoileal diverticulitis) cases surgically treated in our service during the period from 2002 to 2015. MATERIALS AND METHODS We treated 12 cases of jejunoileal complicated diverticulosis. 7 women and 5 men. The mean age was 76 years. The clinical presentation in all cases was acute abdominal pain, one with gastrointestinal bleeding. All cases had leukocytosis, neutrophilia and increased acute phase reactants. All patients underwent emergency abdominal CT. RESULTS In 11 cases, there was consistency between imaging studies and surgical findings. Diverticula were located: jejunum (9) and ileum (3). Urgent exploratory laparotomy was always done and findings were: diverticular perforation with peritonitis (7 cases), diverticular perforation with abscess (4 cases) and in one case an ischemic area with diverticular perforation after embolization. Intestinal resection and anastomosis was performed in all cases. There were no patients, in which the diagnosis of diverticulosis jejunoileal was previously known. Complications were: Clavien I (2), Clavien IIIa (1), Clavien IVb (1), Clavien V (1). CONCLUSIONS Jejunoileal diverticulitis is a rare entity, usually the first sign of onset of diverticular disease not previously known. Abdominal CT is of great diagnostic value. Resection of the affected segment is the treatment of choice.
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Sun M, Hou X, Wang X, Chen G, Zhao Y. Gastrointestinal Mucormycosis of the Jejunum in an Immunocompetent Patient: A Case Report. Medicine (Baltimore) 2017; 96:e6360. [PMID: 28422828 PMCID: PMC5406044 DOI: 10.1097/md.0000000000006360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
RATIONALE Gastrointestinal Mucormycosis (GIM) is a kind of opportunistic fungal infection with poor prognosis. It usually occurs in patients with immune deficiency. We reported a case of immunocompetent male patient. PATIENT CONCERNS This patient was presented as abdominal distension and gastrointestinal bleeding. DIAGNOSES A variety of hemostatic methods was ineffective to stop the bleeding. The patient finally received laparotomy, and the jejunum lesions were found. INTERVENTIONS Pathological examination confirmed it to be gastrointestinal mucormycosis in jejunum. OUTCOMES However, after systemic anti-fungi therapy, the patient died of septic shock. LESSONS The diagnosis mainly relies on pathological examination. Early diagnosis and early application of systemic amphotericin B liposome were fundamental for improving the prognosis.
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Blake-Siemsen JC, Kortright-Farías M, Casale-Menier DR, Gámez-Araujo J. [Digestive bleeding due to jejunal diverticula: A case report and literature review]. CIR CIR 2017; 85 Suppl 1:34-39. [PMID: 28057321 DOI: 10.1016/j.circir.2016.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 11/26/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Bleeding from the small bowel is a rare pathology that represents 5-10% of gastrointestinal bleeding; 0.06% to 5% of cases are due to the presence of diverticula of the small intestine. The majority of diverticula are asymptomatic and present symptoms when there is a complication. CLINICAL CASE We present the case of a 53-year-old male with a history of chronic renal failure and hypertension. While he was hospitalized due to cerebrovascular disease he recurrently presented lower gastrointestinal bleeding that required blood transfusion on several occasions. Upper gastrointestinal bleeding and colon bleeding were ruled out by endoscopy. It was not until an arteriography was performed that we identified bleeding at proximal jejunum level, and therefore we performed a laparotomy. We present the studies and management that the patient underwent. CONCLUSION Although jejunal diverticula are rare, they must be included in the differential diagnosis of lower gastrointestinal bleeding when present in a patient. Arteriography is a study of great use in locating the site, provided the bleeding is more than 0.5ml/minute.
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Omori T, Tokushige K, Kinoshita F, Ito A, Taniai M, Taneichi M, Iizuka B, Itabashi M, Nagashima Y, Yamamoto M, Nakamura S, Hashimoto E. A case of gastrojejunocolic fistula with steatohepatitis. Clin J Gastroenterol 2016; 10:23-31. [PMID: 27995467 DOI: 10.1007/s12328-016-0703-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/28/2016] [Indexed: 11/26/2022]
Abstract
A man in his 30s, who had undergone retrocolic Billroth II reconstruction for perforated duodenal ulcer, presented with watery diarrhea for 2 years and suspected fatty liver. He was referred to our hospital for management of chronic diarrhea, weight loss, hepatopathy and hypoalbuminemia. Initial upper and lower gastrointestinal endoscopies were negative. Since a small bowel lesion was suspected, peroral single-balloon enteroscopy was performed, which identified feces-like residue near the Billroth II anastomotic site and a connection to the colon separate from the afferent and efferent loops. Transanal single-balloon enteroscopy identified a fistula between the gastrojejunal anastomosis and transverse colon, with the scope reaching the stomach transanally. Barium enema confirmed flow of contrast medium from the transverse colon through the fistula to the anastomotic site, allowing the diagnosis of gastrojejunocolic fistula. Liver biopsy showed relatively severe steatohepatitis (Brunt's classification: stage 2-3, grade 3). Resection of the anastomotic site and partial transverse colectomy were performed to remove the fistula, followed by Roux-en-Y reconstruction. Postoperatively, watery diarrhea resolved and the stools became normal. Hepatopathy and hypoproteinemia improved. One year later, liver biopsy showed marked improvement of steatosis. This case demonstrated marked improvement of both diarrhea/nutritional status and steatohepatitis after treatment of gastrojejunocolic fistula, suggesting that the fistula caused non-alcoholic steatohepatitis.
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Parlakgumus A, Ezer A, Tarim A. A Rare Cause of Gastrointestinal Bleeding: Jejunal Diverticulosis. J Coll Physicians Surg Pak 2016; 26:870-871. [PMID: 27806823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 06/08/2016] [Indexed: 06/06/2023]
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Mestiri S, Karoui M, Charachon A, Deux JF, Chaumette MT. Intravascular Papillary Endothelial Hyperplasia of the Jejunum. Int J Surg Pathol 2016; 15:192-5. [PMID: 17478781 DOI: 10.1177/1066896906295825] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Intravascular papillary endothelial hyperplasia is considered to be an unusual form of thrombus organization that is marked by an excessive papillary endothelial proliferation. This lesion has the propensity to occur in the skin and the subcutis. Occurrence in the gastrointestinal tract is very rare. The authors report an exceptional case of a 20-year-old young woman with intravascular papillary endothelial hyperplasia in the jejunum. The patient was referred to the hospital with a 1-week history of melena. The lesion did not recur after surgery. Histopathological examination revealed a papillary endothelial hyperplasia with an underlying arteriovenous malformation.
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Jochmans I, Pirenne J. IMAGES IN CLINICAL MEDICINE. Jejunal Diverticulosis with Midgut Volvulus and Intestinal Malrotation. N Engl J Med 2016; 375:e2. [PMID: 27410948 DOI: 10.1056/nejmicm1511165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Chisci E, de Donato G, Setacci F, Stella A, Setacci C. Recurrent Aortoenteric Fistula: Two Different Bridge Solutions. Vascular 2016; 15:235-7. [PMID: 17714642 DOI: 10.2310/6670.2007.00033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A “recurrent” aortoenteric fistula (AEF) is very rare and in literature anecdotic. Currently, graft excision and extra-anatomic bypass are considered the treatments of choice, but are associated with significant mortality and morbidity. Herein, we describe the case of a “recurrent” AEF treated before definitive extra-anatomic bypass, by two different, staged bridge solutions: allograft in situ replacement and endovascular grafting. At 1, 3 and 6-month follow-up, the patient was asymptomatic and normally active.
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