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Mansour M, Abboud Y, Bilal R, Seilin N, Alsuliman T, Mohamed FK. Small bowel diverticula in elderly patients: a case report and review article. BMC Surg 2022; 22:101. [PMID: 35303837 PMCID: PMC8932322 DOI: 10.1186/s12893-022-01541-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Small intestine diverticula are rare findings that were mostly reported in the elderly population as asymptomatic findings. However, they can also present with a wide range of symptoms (bloating, early satiety, chronic abdominal discomfort, and diarrhea/steatorrhea) or complications (gastrointestinal bleeding, small bowel obstruction, acute diverticulitis, or perforation) which in turn warrant medical treatment or urgent surgical intervention.
Case presentation This is a case report of an 84-year-old female who presented with an acute surgical abdomen. An exploratory laparotomy revealed complicated small bowel diverticula with a jejunal diverticulum perforation, for which a diverticulectomy was performed. Conclusions Throughout this paper, we are aiming to outweigh the consideration of the possibility of complicated small bowel diverticula as a differential in the evaluation of any acute abdomen, especially in the elderly, which warrants emergency surgical management.
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Affiliation(s)
- Marah Mansour
- Faculty of Medicine, Tartous University, Tartous, Syrian Arab Republic.
| | - Yazan Abboud
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Racha Bilal
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Nour Seilin
- Department of Internal Medicine, Damascus Hospital, Damascus, Syrian Arab Republic
| | - Tamim Alsuliman
- Hematology and Cell Therapy Department, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France
| | - Fawaz K Mohamed
- Department of General Surgery, Al-Basel Hospital, Tartous, Syrian Arab Republic
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Guediche A, Amor SB, Mnari W, Abdelaali M, Farhat W, Ammar H, Said MA, Zakhama M, Bouhlel W, Sellem OK, Chaabene NB, Golli M, Ali AB, Safer L. Diverticular disease of the small bowel: a rare cause of the duodenojejunal flexure obstruction (a case report). Pan Afr Med J 2021; 38:213. [PMID: 34046119 PMCID: PMC8140677 DOI: 10.11604/pamj.2021.38.213.27575] [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: 12/24/2020] [Accepted: 02/04/2021] [Indexed: 11/28/2022] Open
Abstract
The small bowel is the least common site for diverticula in the entire gastrointestinal tract. Chronic upper intestinal obstruction due to diverticula is very rare. We report a case of multiple small bowel diverticula causing mechanical obstruction of the duodenojejunal flexure.
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Affiliation(s)
- Arwa Guediche
- Gastroenterology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Soumaya Ben Amor
- Gastroenterology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Walid Mnari
- Radiology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Mabrouk Abdelaali
- Radiology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Waad Farhat
- General Surgery Department, Sahloul Hospital, Sousse, Tunisia
| | - Houcem Ammar
- General Surgery Department, Sahloul Hospital, Sousse, Tunisia
| | | | - Mejda Zakhama
- Gastroenterology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Wided Bouhlel
- Gastroenterology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Om Keltoum Sellem
- Nutrition Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Nabil Ben Chaabene
- Gastroenterology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Mondher Golli
- Radiology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Ali Ben Ali
- General Surgery Department, Sahloul Hospital, Sousse, Tunisia
| | - Leila Safer
- Gastroenterology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
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3
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Yeung E, Kumar V, Dewar Z, Behm R. Rare aetiology of abdominal pain: contained abscess secondary to perforated jejunal diverticulitis. BMJ Case Rep 2020; 13:13/9/e235974. [PMID: 32878834 DOI: 10.1136/bcr-2020-235974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A patient with a history of multiple jejunal diverticulosis (JD) presented with a non-peritonitic abdominal pain and leucocytosis. CT scan showed a thick-walled interloop collection within the left mid-abdomen with dilated bowels and mild diffuse air-fluid levels. Exploratory laparotomy revealed multiple diverticular outpouchings in the mid-jejunum, one of which was perforated, contained within the mesentery. Resection of the contained abscess and primary anastomosis were performed subsequently.
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Affiliation(s)
- Enoch Yeung
- Surgery, Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA
| | - Vishal Kumar
- Surgery, Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA
| | - Zachary Dewar
- Surgery, Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA
| | - Robert Behm
- Surgery, Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA
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Sotirova I, Gklavas A, Papalouka D, Gourtsoyianni S, Christodoulou D, Papaconstantinou I. Multiple Small Bowel Diverticula Were an Unexpected Finding During Laparoscopic Enterectomy for Crohn's Disease. Med Arch 2020; 74:142-145. [PMID: 32577058 PMCID: PMC7296412 DOI: 10.5455/medarh.2020.74.142-145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Small bowel diverticulosis (SBD) is a rare entity. Although it is usually an asymptomatic condition, clinical manifestations may vary from non-specific clinical signs to severe and complicated disease. The coexistence of SBD and Crohn’s disease (CD) is rarely reported in the current literature. Aim: We present a rare case of concomitant Crohn’s disease (CD) and SBD in a male patient, where multiple jejunal diverticula were an incidental intraoperative finding. Preoperative evaluation with magnetic resonance enterography (MRE) failed to recognize the coexistence of these two entities. Surgeons should be aware of the possibility of this rare situation. Case report: A 52-year-old Caucasian male diagnosed with CD was referred to our department for surgical intervention due to an ileal stricture. The patient reported no past medical history, except for a few episodes of bloody diarrhoea during a three-year period. The index colonoscopy revealed luminal narrowing in the ileum at approximately 70 cm proximal to the ileocaecal valve, and biopsies revealed findings compatible with CD. Clinical examination and laboratory tests were unremarkable one day before surgery. The patient underwent laparoscopic segmental resection of the affected part of the ileum. Intraoperatively, multiple non-inflamed diverticula along the jejunum extending from the Treitz ligament to the proximal ileum were recognized. Our patient had an uncomplicated post-operative course and was discharged on the fifth post-operative day. Pathological examination revealed features compatible with CD in the active phase. The patient was referred to his gastroenterological team for further consultation regarding the appropriate post-operative management. Conclusion: Concomitant CD and SBD is a rare condition, and the differential diagnosis may be challenging due to overlapping symptoms.
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Affiliation(s)
- Ira Sotirova
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Antonios Gklavas
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Dimitra Papalouka
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Sofia Gourtsoyianni
- First Department of Radiology, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Dimitrios Christodoulou
- Department of Gastroenterology and Hepatology, University Hospital of Ioannina and Medical School of Ioannina, Ioannina 45110, Greece
| | - Ioannis Papaconstantinou
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens 11528, Greece
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Sarıtaş AG, Topal U, Eray İC, Dalcı K, Akçamı AT, Erdoğan K. Jejunal diverticulosis complicated with perforation: A rare acute abdomen etiology. Int J Surg Case Rep 2019; 63:101-103. [PMID: 31574453 PMCID: PMC6796598 DOI: 10.1016/j.ijscr.2019.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/03/2019] [Accepted: 09/08/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Jejunal diverticulosis is a rare intestinal pathology with an incidence of 0.5-1%. While most cases are asymptomatic, 30-40% of the cases may become symptomatic with chronic abdominal pain, malabsorption, hemorrhage, diverticulitis, obstruction, abscess formation and, rarely, diverticula perforation. It is generally localized on the mesenteric side and it develops from the entry points of the vessels into the jejunum. CASE PRESENTATION Case 1 - A 36-year Case 2 a 75 old female patient patient was admitted to the emergency department with the complaint of widespread abdominal pain, Case 1 8 diverticules, one with diverticule perforation, was observed in the jejunum segment between the 50th and 90th centimeters after the Treitz Ligament. Case 2 - In the diverticulum 100 cm distal from the Treitz ligament, mesenteric perforation area of 4-5 mm were observed. RESULTS Segmentary small bowel resection and side-by-side anastomosis were performed in these cases. In the histopathological examination, the Diverticula were seen to be pseudodiverticullar lesions including herniation of the mucosa and submucosa. CONCLUSION Jejunoileal diverticulosis is a rare disease with life-threatening complications such as perforation, obstruction and bleeding, it is usually asymptomatic or presents with nonspecific symptoms. It should be considered in the differential diagnosis of acute abdomen.
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Affiliation(s)
- Ahmet Gökhan Sarıtaş
- Department of General Surgery, Cukurova University Faculty of Medicine, 01330, Cukurova, Adana, Turkey
| | - Uğur Topal
- Department of General Surgery, Cukurova University Faculty of Medicine, 01330, Cukurova, Adana, Turkey.
| | - İsmail Cem Eray
- Department of General Surgery, Cukurova University Faculty of Medicine, 01330, Cukurova, Adana, Turkey
| | - Kubilay Dalcı
- Department of General Surgery, Cukurova University Faculty of Medicine, 01330, Cukurova, Adana, Turkey
| | - Atılgan Tolga Akçamı
- Department of General Surgery, Cukurova University Faculty of Medicine, 01330, Cukurova, Adana, Turkey
| | - Kıvılcım Erdoğan
- Department of Pathology, Cukurova University Faculty of Medicine, 01330, Cukurova, Adana, Turkey
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De Simone B, Alberici L, Ansaloni L, Sartelli M, Coccolini F, Catena F. Not all diverticulites are colonic: small bowel diverticulitis - A systematic review. MINERVA CHIR 2019; 74:137-145. [DOI: 10.23736/s0026-4733.18.07745-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mohi RS, Moudgil A, Bhatia SK, Seth K, Kaur T. Complicated Jejunal Diverticulosis: Small Bowel Volvulus with Obstruction. IRANIAN JOURNAL OF MEDICAL SCIENCES 2016; 41:548-551. [PMID: 27853337 PMCID: PMC5106572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The incidence of the diverticulum of the small bowel varies from 0.2-1.3% in autopsy studies to 2.3% when assessed on enteroclysis. It occurs mostly in patients in the 6th decade of their life. Of all the small bowel diverticuli, jejunal diverticulum is the most common type. This rare entity is usually asymptomatic. However, they may cause chronic non-specific symptoms for a long period of time like dyspepsia, chronic postprandial pain, nausea, vomiting, borborgymi, alternating diarrhoea and constipation, weight loss, anaemia, steatorrhea or rarely lead to complications like haemorrhage, obstruction, perforation. Obstruction can be due to enterolith, adhesions, intussusception, and volvulus. The condition is difficult to diagnose because patients are generally presented with symptoms that mimic other diseases. It is important for clinicians to have awareness of this entity. Here, we present a case of multiple jejunal diverticuli with a history of repeated attacks of diverticulitis over past 20 years, which were misdiagnosed and now presented with intestinal obstruction due to volvulus of the involved segment along with mesentery around its axis. Resection of the diverticuli segment of jejunum was done with end-to-end jejuno-jejunal anastomosis. The patient is asymptomatic since 10 months of follow-up.
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Affiliation(s)
- Rommel Singh Mohi
- Department of Surgery, Govt. Medical College and Rajindra Hospital Patiala, Punjab, India
| | - Ashish Moudgil
- Department of Surgery, Govt. Medical College and Rajindra Hospital Patiala, Punjab, India,Correspondence: Ashish Moudgil, MS; Department of Surgery, Govt. Medical College and Rajindra Hospital, Patiala Punjab 147001, India Tel: +91 99 88837610
| | - Suresh Kumar Bhatia
- Department of Surgery, Govt. Medical College and Rajindra Hospital Patiala, Punjab, India
| | - Kaushal Seth
- Department of Surgery, Govt. Medical College and Rajindra Hospital Patiala, Punjab, India
| | - Tajinder Kaur
- Intern Govt. Medical College and Rajindra Hospital Patiala, Punjab, India
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Natarajan K, Phansalkar M, Varghese RG, Thangiah G. Jejunal diverticulosis with perforation - a challenging differential diagnosis of acute abdomen: case report. J Clin Diagn Res 2015; 9:ED03-4. [PMID: 25859462 PMCID: PMC4378744 DOI: 10.7860/jcdr/2015/11210.5541] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/10/2014] [Indexed: 11/24/2022]
Abstract
Multiple diverticulosis of the jejunum represents a very rare entity. Jejunal diverticula are found to be the rarest of all small bowel diverticula. The disease is usually asymptomatic and often becomes clinically relevant when complicated. This rarity makes it a difficult differential diagnosis. Related complications such as diverticulitis, perforation, and bleeding and/or intestinal obstruction appear in about 10-30% of the patients which increase the morbidity and mortality rates in such individuals. Here, we present a case of jejunal diverticulosis with perforation who presented with symptoms of acute abdominal pain, vomiting and fever along with a brief review of literature.
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Affiliation(s)
- Kiruthiga Natarajan
- Post Graduate, Department of Pathology, Pondicherry Institute of Medical Sciences, Ganapathychettykulam, Puducherry, India
| | - Manjiri Phansalkar
- Professor, Department of Pathology, Pondicherry Institute of Medical Sciences, Ganapathychettykulam, Puducherry, India
| | - Renu G’boy Varghese
- Professor, Department of Pathology, Pondicherry Institute of Medical Sciences, Ganapathychettykulam, Puducherry, India
| | - G. Thangiah
- Professor, Department of Surgery, Pondicherry Institute of Medical Sciences, Ganapathychettykulam, Puducherry, India
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Fresow R, Vieweg H, Kamusella P, Talanow R, Andresen R. Jejunal diverticulitis ascending to the duodenum as a rare cause of acute abdomen. J Clin Diagn Res 2014; 8:RD07-8. [PMID: 25302248 DOI: 10.7860/jcdr/2014/8968.4723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 06/06/2014] [Indexed: 11/24/2022]
Abstract
We present the case of a 73 year-old Caucasian male with acute abdominal pain, peritonism and vomiting. Due to the severity of symptoms a CT examination of the abdomen was performed. The scans revealed multiple jejunal diverticula, wall thickening of the duodenum and jejunum, and free peritoneal fluid. No clear signs of mesenteric infarction, free abdominal air or abscess formation were seen. An additional exploratory laparotomy was conducted to confirm the CT findings and rule out the need for resection of small bowel. Since the results were matching, conservative therapy was scheduled and the patient recovered well. Jejunal diverticulitis is a rare cause of acute abdomen, however has to be considered as a differential diagnosis to more common entities. It usually stays localized, while in our case the inflammation ascended to the duodenum. CT is the modality of choice to diagnose and rule out potentially life threatening complications.
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Affiliation(s)
- Robert Fresow
- Faculty, Department of Radiology/Neuroradiology, Institute of Diagnostic and Interventional, Westküstenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel , Lübeck and Hamburg, Germany
| | - Hendryk Vieweg
- Faculty, Department of Radiology/Neuroradiology, Institute of Diagnostic and Interventional, Westküstenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel , Hamburg, Germany
| | - Peter Kamusella
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westküstenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel , Lübeck and Hamburg, Germany
| | | | - Reimer Andresen
- Faculty, Department of Radiology/Neuroradiology, Institute of Diagnostic and Interventional, Westküstenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel , Lübeck and Hamburg, Germany
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Aydin I, Pergel A, Yucel AF, Sahin DA. A rare cause of acute abdomen: jejunal diverticulosis with perforation. J Clin Imaging Sci 2013; 3:31. [PMID: 24083068 PMCID: PMC3779396 DOI: 10.4103/2156-7514.115763] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 04/17/2013] [Indexed: 11/04/2022] Open
Abstract
Jejunal diverticulosis is generally asymptomatic and is associated with high morbidity and mortality secondary to complications, especially in elderly patients. We present a case report of a 74-year-old female patient with jejunal diverticulosis and perforation due to diverticulitis.
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Affiliation(s)
- Ibrahim Aydin
- Department of Surgery, Recep Tayyip Erdogan University School of Medicine, Rize, Turkey
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