Radiologic diagnosis of jejunal diverticulitis

Variability in the presentation of complicated jejunal diverticulosis

Jejunal diverticulosis is a rare disease which normally presents for the first time with acute complications, often requiring surgical intervention. The diverticulae are acquired, occurring more commonly after middle age, but their aetiology is unclear. We discuss this condition in the context of four cases which presented to our hospital as emergencies over a five year period: small bowel obstruction, gastrointestinal haemorrhage, small bowel volvulus, and visceral perforation. Our aim is to encourage clinicians to include jejunal diverticular disease as a differential diagnosis in patients with abdominal symptoms.

Small intestinal nonmeckelian diverticulosis

Nonmeckelian jejunoileal diverticula (JID) are rare, but potentially clinically significant lesions. Despite recent advances in modern diagnostic modalities, diagnosis of JID may be problematic. Upper gastrointestinal contrast series with small bowel follow-through examination and mainly enteroclysis are the 2 main diagnostic methods. In selected cases (mainly complicated JID), the physician could use other diagnostic methods, such as ultrasound, computed tomography, endoscopy, intraoperative endoscopy, laparoscopy, radiotagged erythrocyte bleeding scans, and selective mesenteric arteriography. JID may be clinically silent or symptomatic causing chronic pain or malabsorption or other acute complications, such as hemorrhage, inflammation, perforation, etc. Laparotomy remains the gold standard for definite diagnosis of asymptomatic and complicated diverticula. Treatment should be individualized. Surgery could be indicated, mainly in symptomatic diverticula. The extent of resection may be a problem, especially in patients with extensive disease involving large parts of the bowel. In these cases, clinical judgment is required from the part of surgeon to avoid short bowel syndrome.

Analysis of clinical manifestations of symptomatic acquired jejunoileal diverticular disease

AIM: To analyze systematically our experience over 22 years with symptomatic acquired diverticular disease of the jejunum and ileum, exploring the clinical manifestations and diagnosis of this rare but life-threatening disease.

METHODS: The medical records of patients with surgically confirmed symptomatic jejunoileal diverticular disease were retrospectively reviewed. Data collected included demographic data, laboratory results, clinical course (acute or chronic), preoperative diagnosis, and operative findings. Inclusion criteria were as follows: (1) surgical confirmation of jejunoileal diverticular disease and (2) exclusion of congenital diverticula (e.g. Meckel’s diverticulum).

RESULTS: From January 1982 to July 2004, 28 patients with a total of 29 operations met the study criteria. The male:female ratio was 14:14, and the mean age was 62.6±3.5 years. The most common manifestation was abdominal pain. In nearly half of the patients, the symptoms were chronic. Two patients died after surgery. Only four cases were correctly diagnosed prior to surgery, three by small bowel series.

CONCLUSION: Symptomatic acquired small bowel diverticular disease is difficult to diagnose. It should be considered in older patients with unexplained chronic abdominal symptoms. A small bowel series may be helpful in diagnosing this potentially life-threatening disease.

Ectopic pancreas complicated by pancreatitis and pseudocyst formation mimicking jejunal diverticulitis

Clinical symptoms are rarely produced by ectopic pancreas arising in the jejunum. We report a case of a patient with left lower quadrant abdominal pain due to jejunal ectopic pancreas complicated by acute pancreatitis and pseudocyst formation.

Perforated jejunal diverticulum: CT diagnosis

A case of a perforated jejunal diverticulum with retroperitoneal extension is presented. Computed tomographic (CT) features and the plain radiographic appearance are described in this rare complication of a common pathologic finding.

Diverticulitis of the jejunum: clinical and radiological features

This article describes three cases of jejunal diverticulitis in elderly women, who had presented with pain and tenderness in the periumbilical region or the left side of the abdomen, low-grade fever, anemia, and weight loss. The findings were initially attributed to possible inflammatory or neoplastic lesions of the colon. However, gastrointestinal barium studies and computed tomography (CT) of the abdomen proved crucial in establishing the preoperative diagnosis of jejunal diverticulitis and its associated abscess in the adjacent mesentery or abdominal wall. The clinical and radiological manifestations of this uncommon entity are herein presented along with a brief review of the pertinent literature.