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Chiorescu S, Mocan M, Santa ME, Mihăileanu F, Chiorescu RM. Acute complicated jejunum diverticulitis: a case report with a short literature review. Front Med (Lausanne) 2024; 11:1413254. [PMID: 38818398 PMCID: PMC11138148 DOI: 10.3389/fmed.2024.1413254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 04/23/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction Jejunal diverticulosis is a rare condition. Most of the time, it is asymptomatic; but it can cause severe complications such as intestinal perforation, mechanical occlusion, and hemorrhage. Case presentation A patient aged 78 years, with a history of biological aortic valve prosthesis, atrial fibrillation, type 2 diabetes mellitus, and chronic obstructive pulmonary disease, presented in the emergency department for acute abdominal pain in the lower abdominal floor, nausea, and inappetence. Abdominal computed tomography revealed an inflammatory block in the hypogastrium, agglutinated small intestinal loops, fecal stasis, and air inclusions. Pulled mesentery and associated internal hernia are suspected. Exploratory laparotomy was performed, revealing an inflammatory block in the hypogastrium, whose dissection revealed inner purulent collection and the appearance of jejunal diverticulitis, a diagnosis confirmed by histopathological examination. Segmental resection of the jejunum with double-layer terminal-terminal enteroenteric anastomosis, lavage, and drainage was performed. The evolution was favorable. Conclusion Based on our brief review, the diagnosis of complicated jejunal diverticulosis is difficult and sometimes not accurately established, even by high-resolution imaging techniques, with diagnostic laparotomy being necessary for these situations. Surgical treatment should be considered before severe complications develop.
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Affiliation(s)
- Stefan Chiorescu
- Department of Surgery, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Surgery, Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - Mihaela Mocan
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Internal Medicine, Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - Maria Elena Santa
- Department of Hematology, Oncology Institute "Prof. Dr. Ion Chiricuta ", Cluj-Napoca, Romania
| | - Florin Mihăileanu
- Department of Surgery, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Surgery, Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - Roxana Mihaela Chiorescu
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Internal Medicine, Emergency Clinical County Hospital, Cluj-Napoca, Romania
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2
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Ju J, Su Y, Zeng Q, Liang J, Zhang X, Ren J, Wu L, Zheng R. Sonographic features of Lemmel's syndrome: Differential diagnosis from stones in the lower portion of the common bile duct. Arab J Gastroenterol 2024; 25:143-149. [PMID: 38403494 DOI: 10.1016/j.ajg.2024.01.003] [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: 10/25/2022] [Revised: 09/28/2023] [Accepted: 01/03/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND STUDY AIMS Periampullary diverticula (PAD), a location-specific type of duodenal diverticula, can cause serious complications. PAD is difficult to differentially diagnose, mainly due to its nonspecific symptoms. This study aimed to identify sonographic features of PAD and to evaluate their value in the differential diagnosis of PAD from stones in the lower common bile duct (CBD). PATIENTS AND METHODS A total of 30 patients with PAD and 60 patients with lower CBD stones were retrospectively enrolled, and sonographic features were analyzed. Measurements of sonographic features included echo shaped, posterior echo changes, location and relation to surrounding organs, and status of intrahepatic and extrahepatic bile duct dilation, and their diagnostic performance was assessed. RESULTS Characteristic sonographic features of PAD were identified, including strong echoes (28/30, 93.3 %), strip shape (28/30, 93.3 %), multiple reflections in the posterior echo (27/30, 90.0 %), and location outside the CBD or near the biliary wall in connection with the duodenum (27/30, 90.0 %). Inter-observer agreement was good (Kappa values = 0.69-0.82). Comparative analysis of sonographic features revealed significant differences in echo shape, posterior echo changes (multiple reflections and acoustic shadowing), location and relation to surrounding organs, and intrahepatic and extrahepatic bile duct dilatation status between the dilatation status of the two groups. In particular, these characteristics achieved a sensitivity of 100 % and a specificity of 98 % for the differential diagnosis of PAD and lower CBD stones. CONCLUSIONS This study identified characteristic sonographic features of PAD, which could be used as potential diagnostic indicators to distinguish PAD from lower CBD stones.
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Affiliation(s)
- Jinxiu Ju
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, China
| | - Yating Su
- Department of Ultrasound, The First Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Qingjing Zeng
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, China.
| | - Jiayi Liang
- Huangpu District Luogang Street Community Health Service Center, Guangzhou, Guangdong, P.R. China
| | - Xiaodan Zhang
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, China.
| | - Jie Ren
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, China.
| | - Lili Wu
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, China.
| | - Rongqin Zheng
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, China.
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3
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Suro Santos Y, Fematt-Rodriguez BJ, Gonzalez-Ruiz JA, Fuentes-Hernandez JE, Juarez-Garcia ML. Acute Abdomen Secondary to Ileal Diverticulum: A Case Report. Cureus 2023; 15:e48693. [PMID: 38024071 PMCID: PMC10640899 DOI: 10.7759/cureus.48693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2023] [Indexed: 12/01/2023] Open
Abstract
Small-bowel diverticulosis is rare. We report the case of a male with an acute abdomen secondary to an ileal diverticulum. A 46-year-old male complained of progressive abdominal pain over 24 hours of evolution in the left flank. On physical examination, we found abdominal pain in the left flank and mesogastrium, tenderness, and signs of peritonitis. The simple abdominal CT showed a heterogeneous tubular image in the small bowel. We performed a diagnostic laparoscopy and found a normal cecal appendix. There was no free abdominal fluid or adhesions, and the colon was without diverticula. We found a single diverticulum of 4 cm in length and 2 cm in diameter in the small intestine and therefore converted the procedure to a laparotomy. We performed a bowel resection including the diverticulum and intestinal anastomosis. The patient reported remission of symptoms after surgery.
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Affiliation(s)
- Yeudiel Suro Santos
- General Surgery, Instituto Mexicano del Seguro Social, Hospital General de Zona No. 33, Monterrey, MEX
| | - Brando J Fematt-Rodriguez
- General Surgery, Instituto Mexicano del Seguro Social, Hospital General de Zona No. 33, Monterrey, MEX
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4
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Ritchie TW, Wargel ZM, Shapera E, Wheeler AA. Duodenal Diverticulitis Following Biliopancreatic Diversion: A Case Report. Cureus 2023; 15:e45219. [PMID: 37842381 PMCID: PMC10571382 DOI: 10.7759/cureus.45219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Duodenal diverticulitis is a relatively uncommon finding in patients. Treatment of complications of duodenal diverticulitis may be challenging in patients with altered intestinal anatomy such as those with altered anatomy from weight loss procedures involving intestinal bypass. We present a case report describing the management of duodenal diverticulitis following a biliopancreatic diversion, our decision-making process, and our final treatment strategy.
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Affiliation(s)
| | - Zachary M Wargel
- Surgery, University of Missouri School of Medicine, Columbia, USA
| | - Emanuel Shapera
- General Surgery, Grossmont Surgical Associates, San Diego, USA
| | - Andrew A Wheeler
- Surgery, University of Missouri School of Medicine, Columbia, USA
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5
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Wang LW, Chen P, Liu J, Jiang ZW, Liu XX. Small bowel diverticulum with enterolith causing intestinal obstruction: A case report. World J Gastrointest Surg 2023; 15:1256-1261. [PMID: 37405091 PMCID: PMC10315109 DOI: 10.4240/wjgs.v15.i6.1256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Small bowel diverticula are rare in clinics, and small intestinal obstruction caused by coprolites is rarer and difficult to diagnose early. The true incidence of these diverticula may be underestimated due to their clinical symptoms not differing from those of small bowel obstruction resulting from other causes. It is common in the elderly, although it can occur at any age.
CASE SUMMARY This is a case report of a 78-year-old man with epigastric pain for 5 d. Conservative treatment does not effectively relieve pain, inflammatory indicators are elevated, and computed tomography suggests jejunal intussusception and mild ischemic changes in the intestinal wall. Laparoscopic exploration showed that the left upper abdominal loop was slightly edematous, the jejunum mass at the near Flex ligament was palpable, the size was about 7 cm × 8 cm, the local movement was slight, and the diverticulum was seen 10 cm downward, and the local small intestine was dilated and edema. Segmentectomy was performed. After the short parenteral nutrition after surgery, the fluid and enteral nutrition solution were pumped through the jejunostomy tube, and the patient was discharged after the treatment was stable, and the jejunostomy tube was removed in an outpatient clinic one month after the operation. Postoperative pathology: Jejunectomy specimen: (1) Small intestinal diverticulum with chronic inflammation, ulcer with full-thickness activity, and necrosis of the intestinal wall in some areas; (2) also see that the hard object is consistent with stone changes; and (3) the incision margin on both sides shows chronic inflammation of mucosal tissue.
CONCLUSION Clinically, the diagnosis of small bowel diverticulum is difficult to distinguish from jejunal intussusception. Combined with the patient’s condition, rule out other possibilities after a timely disease diagnosis. According to the patient’s body tolerance adopt personalized surgical methods to achieve better recovery after surgery.
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Affiliation(s)
- Li-Wen Wang
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
| | - Peng Chen
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
| | - Jiang Liu
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
| | - Zhi-Wei Jiang
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
| | - Xin-Xin Liu
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
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6
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Pajtak R, Ramadan A, Strauss P. Strangulated diverticulum: a new acute complication of small bowel diverticulosis. J Surg Case Rep 2023; 2023:rjad253. [PMID: 37201110 PMCID: PMC10187469 DOI: 10.1093/jscr/rjad253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/14/2023] [Indexed: 05/20/2023] Open
Abstract
Complicated jejunal diverticulosis is a difficult entity to diagnose, which can cause significant morbidity and mortality. We present the case of an 88-year-old female who presented with a unique complication of small bowel diverticulosis progressing to a strangulated diverticulum requiring emergency surgery. We present the case of an 88-year-old female who presented with abdominal pain associated with a new mass on a background of perforated diverticulitis and previous laparoscopic abdominal surgeries for division of adhesions. Due to high suspicion for the mass containing necrotic bowel, the patient was taken directly to theatre for an exploratory laparotomy and was found to have ischaemic small bowel secondary to a strangulated jejunal diverticulum. When evaluating the acute abdomen consideration should be given to the diagnosis of a strangulated jejunal diverticulum causing ischaemic small bowel, with a view to expedite to emergency surgery as the primary treatment.
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Affiliation(s)
- Renata Pajtak
- Correspondence address. General Surgery, Central Gippsland Health, 155 Guthridge Parade Sale, Melbourne, VIC 3850, Australia. Tel: (03)5143 8600; Fax: (03) 5143 8633; E-mail:
| | - Abdullah Ramadan
- Department of General Surgery, Central Gippsland Health, 155 Guthridge Parade Sale, Melbourne, VIC 3850, Australia
| | - Paul Strauss
- Department of General Surgery, Central Gippsland Health, 155 Guthridge Parade Sale, Melbourne, VIC 3850, Australia
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7
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Onken F, Senne M, Königsrainer A, Wichmann D. Classification und Treatment Algorithm of Small Bowel Perforations Based on a Ten-Year Retrospective Analysis. J Clin Med 2022; 11:jcm11195748. [PMID: 36233616 PMCID: PMC9572575 DOI: 10.3390/jcm11195748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/19/2022] [Accepted: 09/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Small bowel perforations are a rare diagnosis compared with esophageal, gastric, and colonic perforations. However, small bowel perforations can be fatal if left untreated. A classification of small bowel perforations or treatment recommendations do not exist to date. Methods: A retrospective, monocentric, code-related data analysis of patients with small bowel perforations was performed for the period of 2010 to 2019. Results: Over a 10-year period, 267 cases of small bowel perforation in 257 patients (50.2% male and 49.8% female; mean age of 60.28 years) were documented. Perforation’s localization was 5% duodenal, 38% jejunal, 39% ileal, and 18% undocumented. Eight etiologies were differentiated: iatrogenic (41.9%), ischemic (20.6%), malignant (18.9%), inflammatory (8.2%), diverticula-associated (4.5%), traumatic (4.5%), foreign-body-associated (1.9%), and cryptical (1.5%) perforations. Operative treatment combined with antibiotics was the most commonly used therapeutic approach (94.3%). The mortality rate was 14.23%, with highest rate for patients with ischemic perforations. Discussion: An algorithm for diagnostic and therapeutic steps was established. Furthermore, it was found that small bowel perforations are rare events with poor outcomes. Time to diagnosis and grade of underlying disease are the most essential parameters to predict perforation-associated complications.
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Affiliation(s)
- Flurina Onken
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Tübingen, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
| | - Moritz Senne
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
- Correspondence: ; Tel.: +49-7071-2968165
| | - Alfred Königsrainer
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Dörte Wichmann
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
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8
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Karna R, Rana T, Mohy-Ud-Din N, Chaudhary D, Appasamy R. Acute hypotensive hematochezia due to jejunal diverticular bleed. Proc AMIA Symp 2022; 35:854-855. [DOI: 10.1080/08998280.2022.2097573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Affiliation(s)
- Rahul Karna
- Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Tabeer Rana
- Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Nabeeha Mohy-Ud-Din
- Division of Gastroenterology and Hepatology, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Dhruv Chaudhary
- Division of Gastroenterology and Hepatology, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Ragunath Appasamy
- Clinical Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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9
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Zhang H, Yang Z, Wang YH, Yang SM, Liu L, Bai JY, Fan CQ. Typical gastric mucosa with ulcer found by endoscopy in Meckel's diverticulum. Endoscopy 2022; 54:E154-E155. [PMID: 33910256 DOI: 10.1055/a-1471-1857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Hong Zhang
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.,Department of Gastroenterology, Xinqiao Hospital, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Zhen Yang
- Department of Gastroenterology, Xinqiao Hospital, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yan-Hong Wang
- Department of Gastroenterology, Xinqiao Hospital, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Shi-Ming Yang
- Department of Gastroenterology, Xinqiao Hospital, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Lu Liu
- Department of Gastroenterology, Xinqiao Hospital, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Jian-Ying Bai
- Department of Gastroenterology, Xinqiao Hospital, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Chao-Qiang Fan
- Department of Gastroenterology, Xinqiao Hospital, the Second Affiliated Hospital of Army Medical University, Chongqing, China
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10
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Ponce Beti MS, Palacios Huatuco RM, Picco S, Capra AE, Perussia DG, Suizer AM. Complicated jejunal diverticulosis with intestinal perforation and obstruction: delay in hospital visit during confinement due to COVID-19. J Surg Case Rep 2022; 2022:rjac010. [PMID: 35169438 PMCID: PMC8840888 DOI: 10.1093/jscr/rjac010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/31/2021] [Accepted: 01/04/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Diverticulosis of the small bowel is a rare entity. It can cause acute, complications such as diverticulitis, perforation, intestinal bleeding and obstruction. During the pandemic, patients were reluctant to visit hospitals for fear of contracting coronavirus disease 2019. This caused the patients to wait until the extreme deterioration of many acute surgical conditions. An 83-year-old man with multiple comorbidities showed up at the emergency department with generalized abdominal pain of 7 days of evolution. The computed tomography scan revealed a large distention of the small intestine and a small inflammatory abscess. He was transferred to the operating room where a segment of the jejunum affected by multiple diverticula located on the mesenteric side of the intestine and a mesenteric abscess related to a perforated jejunal diverticulum were identified. Complicated jejunal diverticulosis is a difficult entity to diagnose, which can cause significant morbidity and mortality. To avoid this, its timely diagnosis is essential.
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Affiliation(s)
- María S Ponce Beti
- Department of General Surgery, Hospital Militar Regional Córdoba, Av. Cruz Roja Argentina 1174, Córdoba Capital, Argentina
| | - René M Palacios Huatuco
- Department of General Surgery, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo 1248, Córdoba Capital, Argentina
| | - Santiago Picco
- Department of General Surgery, Hospital Militar Regional Córdoba, Av. Cruz Roja Argentina 1174, Córdoba Capital, Argentina
| | - Alejandro E Capra
- Department of General Surgery, Hospital Militar Regional Córdoba, Av. Cruz Roja Argentina 1174, Córdoba Capital, Argentina
| | - Daniel G Perussia
- Department of General Surgery, Hospital Militar Regional Córdoba, Av. Cruz Roja Argentina 1174, Córdoba Capital, Argentina
| | - Alejando M Suizer
- Department of General Surgery, Hospital Militar Regional Córdoba, Av. Cruz Roja Argentina 1174, Córdoba Capital, Argentina
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Lamb R, Kahlon A, Sukumar S, Layton B. Small bowel diverticulosis: imaging appearances, complications, and pitfalls. Clin Radiol 2022; 77:264-273. [PMID: 35012738 DOI: 10.1016/j.crad.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 12/02/2021] [Indexed: 12/19/2022]
Abstract
Diverticula of the small bowel can be categorised as true, with Meckel's being the only example, or false. False small bowel diverticula (SBD) are acquired through herniation of the internal layers of the bowel wall through the muscularis propria. Peri-ampullary duodenal diverticula are a well-recognised example; however, the importance of more distal SBD in the jejunum and ileum is underappreciated, and they are under-reported on cross-sectional imaging. SBD are a known cause of anaemia, malabsorption, and diarrhoea, and there are myriad complications of SBD and Meckel's diverticula, which range in severity from inflammation and perforation to haemorrhage, tumour formation, and obstruction. Before the advent of computed tomography (CT), SBD were readily diagnosed on fluoroscopic oral contrast studies; however, radiologists are less comfortable with their cross-sectional imaging appearances. This imaging review combines our experience of multiple proven cases, with illustrative diagrams and radiological images of SBD to provide distinct imaging characteristics, allowing for confident diagnosis of SBD and their numerous complications. We discuss the importance of SBD as a cause of benign, non-surgical pneumoperitoneum. We additionally provide important pitfalls to be aware of such as SBD masquerading as other abnormalities.
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Affiliation(s)
- R Lamb
- Department of Clinical Radiology, East Lancashire Hospitals Trust, Haslingden Rd, Blackburn, BB2 3HH, UK
| | - A Kahlon
- Department of Clinical Radiology, East Lancashire Hospitals Trust, Haslingden Rd, Blackburn, BB2 3HH, UK
| | - S Sukumar
- Department of Clinical Radiology, University Hospital of South Manchester, Southmoor Road, Manchester, Greater Manchester, M23 9LT, UK
| | - B Layton
- Department of Clinical Radiology, East Lancashire Hospitals Trust, Haslingden Rd, Blackburn, BB2 3HH, UK.
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12
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Barr R, Freeman C, Culhane J. Eosinophilic Gastroenteritis Causing Small Bowel Diverticulosis and Volvulus: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933180. [PMID: 34608111 PMCID: PMC8503799 DOI: 10.12659/ajcr.933180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient: Female, 83-year-old
Final Diagnosis: Eosinophilic gastroentritis • jejunal diverticulosis
Symptoms: Abdominal pain • obstruction
Medication: —
Clinical Procedure: —
Specialty: Surgery
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Affiliation(s)
- Rebecca Barr
- Department of General Surgery, Saint Louis University, St Louis, MO, USA
| | - Carl Freeman
- Department of General Surgery, Saint Louis University, St Louis, MO, USA
| | - John Culhane
- Department of General Surgery, Saint Louis University, St Louis, MO, USA
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13
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Ben Ismail I, Ben Chaabene H, Rebii S, Zoghlami A. Perforated Jejunal Diverticulitis: a rare cause of acute abdominal pain. Clin Case Rep 2021; 9:e04594. [PMID: 34401167 PMCID: PMC8351611 DOI: 10.1002/ccr3.4594] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/13/2021] [Accepted: 06/28/2021] [Indexed: 12/20/2022] Open
Abstract
It is imperative for surgeons to have a heightened awareness of complications of jejunal diverticular disease so that they can act quickly and contribute to a successful clinical outcome for their patients.
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Affiliation(s)
- Imen Ben Ismail
- Department of general surgery, Trauma and Burns CenterUniversity of Tunis El ManarBen ArousTunisia
| | - Hamadi Ben Chaabene
- Department of general surgery, Trauma and Burns CenterUniversity of Tunis El ManarBen ArousTunisia
| | - Saber Rebii
- Department of general surgery, Trauma and Burns CenterUniversity of Tunis El ManarBen ArousTunisia
| | - Ayoub Zoghlami
- Department of general surgery, Trauma and Burns CenterUniversity of Tunis El ManarBen ArousTunisia
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14
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Gosangi B, Rocha TC, Duran-Mendicuti A. Imaging Spectrum of Duodenal Emergencies. Radiographics 2021; 40:1441-1457. [PMID: 32870765 DOI: 10.1148/rg.2020200045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The duodenum, the first portion of the small bowel, is divided into four segments and extends to both retro- and intraperitoneal spaces. Some conditions arise primarily from the duodenum, but it can be secondarily affected by processes that involve neighboring structures. When duodenal emergencies are not identified and treated promptly, they may result in high morbidity and mortality. Imaging plays an important role in the diagnosis of duodenal conditions in the acute setting. However, the radiologic findings can be subtle, and awareness of relevant patient history and clinical presentation is important as it may increase the index of suspicion and one's ability to diagnose these conditions. Duodenal peptic disease is common and can be complicated by bleeding and perforation. The duodenum can be secondarily involved by pancreatitis and gallbladder pathologic conditions and may be affected by iatrogenic complications following endoscopic procedures. Traumatic injuries to the duodenum are generally uncommon, with penetrating traumatic injury being the most frequent mechanism of injury. Duodenal vascular pathologic conditions such as aortoduodenal fistula are uncommon but can be life threatening. The knowledge of which pathologic condition can involve which duodenal segment can help the radiologist establish a differential diagnosis and achieve a more targeted imaging approach. The online slide presentation from the RSNA Annual Meeting is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Babina Gosangi
- From the Department of Radiology, Divison of Emergency Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Tatiana C Rocha
- From the Department of Radiology, Divison of Emergency Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Alejandra Duran-Mendicuti
- From the Department of Radiology, Divison of Emergency Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
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Watanabe Y, Murata M, Hirota M, Suzuki R. Whole jejunoileal diverticulosis with recurrent inflammation and perforation: A case report. Int J Surg Case Rep 2021; 84:106020. [PMID: 34119945 PMCID: PMC8196046 DOI: 10.1016/j.ijscr.2021.106020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/22/2021] [Accepted: 05/22/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Jejunoileal diverticulitis is uncommon and poorly understood. We report a case of whole jejunoileal diverticulosis with recurrent inflammation and perforation. Case presentation A 72-year-old man with hemodialysis presented with fever and abdominal pain. The patient had a medical history of twice having jejunoileal diverticulitis. Serum testing indicated a white blood cell count of 15,670/μL and a C-reactive protein level of 10.31 mg/dL. Contrast-enhanced computed tomography showed jejunoileal diverticulosis with the concomitant mesenteric fat opacity and a 60-mm × 45-mm mass lesion containing extraluminal air bubbles. Jejunoileal partial resection was performed. Multiple diverticulosis was recognized over the entire jejunoileum, and the pouches existed along entry points of the bowel vascular supply through the mesentery. Intestinal resection was limited to the intestinal loop associated with complicated diverticulitis with abscess. Macroscopic examination revealed multiple jejunoileal diverticulosis. In the reddened mucosa, the diverticulitis and mesenteric perforation were recognized. Microscopic examination showed protrusion of mucosal and submucosal layers through a defect in the muscular layer with gangrenous inflammation. These findings supported a diagnosis of jejunoileal diverticulitis with perforation and abscess. The patient had no postoperative complications and no recurrence within 6 months. Discussion Treatment for jejunoileal diverticulitis should be individualized for each patient according to their degree of inflammation, recurrence, and the patient's background. Conclusion Extensive diverticulosis over the entire jejunoileum is very rare. In this case, the section of the inflamed diverticulosis can be distinguished and resected to avoid a short-bowel syndrome, which should lead to an uneventful postoperative course. Jejunoileal diverticulitis is uncommon in clinical practice and poorly understood. Multiple diverticula were recognized over the entire jejunoileum in our case. Treatment for jejunoileal diverticulitis should be individualized for each patient. The section involving only the inflamed diverticulosis should be resected to avoid a short-bowel.
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Affiliation(s)
- Yoshifumi Watanabe
- Department of Surgery, Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka, Japan.
| | - Masaru Murata
- Department of Surgery, Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka, Japan.
| | - Masashi Hirota
- Department of Surgery, Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka, Japan.
| | - Rei Suzuki
- Department of Surgery, Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka, Japan.
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Shi M, Choi YM, Kiselak E. Recurrent spontaneous small bowel perforations with a rare pathology: non-familial visceral myopathy. BMJ Case Rep 2021; 14:14/5/e240923. [PMID: 33986007 PMCID: PMC8126300 DOI: 10.1136/bcr-2020-240923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Visceral myopathy is a rare, often misdiagnosed disease characterised by abnormalities in the gastrointestinal smooth muscle layer. Its clinical presentation includes pseudo-obstruction, intestinal dysmotility and spontaneous perforation. We report an atypical case of a 51-year-old man with a history of recurrent small bowel perforations who presented with an acute abdomen. A laparotomy was performed with identification of a distal jejunal perforation. A small bowel resection with end-to-end anastomosis was done. Minimal adhesions were seen intraoperatively despite the patient's multiple prior surgeries. Pathology showed histiocytic inflammation and patchy loss of the muscle layer reflective of visceral myopathy. Genetic testing revealed a variant of uncertain significance in the myosin light chain kinase gene. It is difficult to make a conclusive diagnosis given the patient's clinical presentation closely mimicking other gastrointestinal disorders. However, it is crucial to consider visceral myopathy in patients with recurrent spontaneous intestinal perforations as a differential diagnosis.
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Affiliation(s)
- Meiyi Shi
- Department of Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Young Mee Choi
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Elizabeth Kiselak
- Department of Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
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Hardon SF, den Boer FC, Aallali T, Fransen GA, Muller S. Perforated jejunal diverticula in a young woman: A case report. Int J Surg Case Rep 2021; 81:105838. [PMID: 33887834 PMCID: PMC8050722 DOI: 10.1016/j.ijscr.2021.105838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Small bowel diverticulosis is a rare condition. It usually remains asymptomatic and undiscovered, until potentially severe complications such as diverticulitis or even perforation occur. We present an unusual case and discuss the pathophysiology, diagnostics strategies, and possible surgical intervention. CASE PRESENTATION A young woman was referred to our emergency department suffering from acute abdominal pain. A computed tomography scan showed signs of small bowel perforation of unknown origin. Exploratory laparotomy revealed multiple perforated jejunal diverticula (JD). The patient underwent segmental resection of the affected jejunum followed by primary anastomosis. Pathological examination confirmed the diagnosis of perforated JD. CONCLUSIONS Due to its rarity and variable clinical presentation, it can sometimes be challenging to diagnose this potentially life-threatening condition. If the bowel is suspected from perforation; segmental resection is the treatment of choice, preferably followed by direct restoration of the bowel continuity.
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Affiliation(s)
- Sem F Hardon
- Department of Surgery, Zaans Medical Center, Zaandam, the Netherlands; Department of Surgery, Amsterdam UMC - VU University Medical Center, Amsterdam, the Netherlands.
| | - Frank C den Boer
- Department of Surgery, Zaans Medical Center, Zaandam, the Netherlands; Department of Surgery, Amsterdam UMC - VU University Medical Center, Amsterdam, the Netherlands
| | - Tarik Aallali
- Symbiant Pathology Expert Centre, Hoorn/Zaandam, the Netherlands
| | - Gerwin A Fransen
- Department of Radiology, Zaans Medical Center, Zaandam, the Netherlands
| | - Sandra Muller
- Department of Surgery, Zaans Medical Center, Zaandam, the Netherlands
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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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Affiliation(s)
- Ewa Grudzińska
- Department of Gastrointestinal Surgery, Medical University of Silesia, 40-752 Katowice, Poland; (E.G.); (K.K.)
| | - Sławomir Mrowiec
- Department of Gastrointestinal Surgery, Medical University of Silesia, 40-752 Katowice, Poland; (E.G.); (K.K.)
- Correspondence: ; Tel.: +48-6-0145-7648
| | | | - Monika Ciupińska
- Department of Pathomorphology and Molecular Diagnostics, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Katarzyna Kusnierz
- Department of Gastrointestinal Surgery, Medical University of Silesia, 40-752 Katowice, Poland; (E.G.); (K.K.)
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Nasef NA, Mehta S. Role of Inflammation in Pathophysiology of Colonic Disease: An Update. Int J Mol Sci 2020; 21:E4748. [PMID: 32635383 PMCID: PMC7370289 DOI: 10.3390/ijms21134748] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/28/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023] Open
Abstract
Diseases of the colon are a big health burden in both men and women worldwide ranging from acute infection to cancer. Environmental and genetic factors influence disease onset and outcome in multiple colonic pathologies. The importance of inflammation in the onset, progression and outcome of multiple colonic pathologies is gaining more traction as the evidence from recent research is considered. In this review, we provide an update on the literature to understand how genetics, diet, and the gut microbiota influence the crosstalk between immune and non‑immune cells resulting in inflammation observed in multiple colonic pathologies. Specifically, we focus on four colonic diseases two of which have a more established association with inflammation (inflammatory bowel disease and colorectal cancer) while the other two have a less understood relationship with inflammation (diverticular disease and irritable bowel syndrome).
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Affiliation(s)
- Noha Ahmed Nasef
- Riddet Institute, Massey University, Private Bag 11222, Palmerston North 4442, New Zealand
| | - Sunali Mehta
- Department of Pathology, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand
- Maurice Wilkins Centre for Biodiscovery, University of Otago, Dunedin 9054, New Zealand
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Tursi A, Scarpignato C, Strate LL, Lanas A, Kruis W, Lahat A, Danese S. Colonic diverticular disease. Nat Rev Dis Primers 2020; 6:20. [PMID: 32218442 PMCID: PMC7486966 DOI: 10.1038/s41572-020-0153-5] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2020] [Indexed: 12/12/2022]
Abstract
Diverticula are outpouchings of the intestinal wall and are common anatomical alterations detected in the human colon. Colonic diverticulosis (the presence of diverticula in the colon; referred to as diverticulosis) remains asymptomatic in most individuals but ~25% of individuals will develop symptomatic diverticulosis, termed colonic diverticular disease (also known as diverticular disease). Diverticular disease can range in severity from symptomatic uncomplicated diverticular disease (SUDD) to symptomatic disease with complications such as acute diverticulitis or diverticular haemorrhage. Since the early 2000s, a greater understanding of the pathophysiology of diverticulosis and diverticular disease, which encompasses genetic alterations, chronic low-grade inflammation and gut dysbiosis, has led to improvements in diagnosis and management. Diagnosis of diverticular disease relies on imaging approaches, such as ultrasonography, CT and MRI, as biomarkers alone are insufficient to establish a diagnosis despite their role in determining disease severity and progression as well as in differential diagnosis. Treatments for diverticular disease include dietary fibre, pharmacological treatments such as antibiotics (rifaximin), anti-inflammatory drugs (mesalazine) and probiotics, alone or in combination, and eventually surgery. Despite being effective in treating primary disease, their effectiveness in primary and secondary prevention of complications is still uncertain.
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Affiliation(s)
- Antonio Tursi
- Territorial Gastroenterology Service, Azienda Sanitaria Locale Barletta-Andria-Trani, Andria, Italy.
| | - Carmelo Scarpignato
- Faculty of Health Sciences, LUdeS Lugano Campus, Lugano, Switzerland
- United Campus of Malta, Birkirkara, Msida, Malta
| | - Lisa L Strate
- Division of Gastroenterology, Department of Medicine, Harborview Medical Center, University of Washington Medical School, Seattle, WA, USA
| | - Angel Lanas
- Service of Digestive Diseases, University Clinic Hospital Lozano Blesa, University of Zaragoza, IIS Aragón (CIBERehd), Zaragoza, Spain
| | | | - Adi Lahat
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center - IRCCS -, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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