Small intestinal diverticulum with bleeding: Case report and literature review

Small bowel diverticulum with enterolith causing intestinal obstruction: A case report

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.

Diagnosis of Nonperitonealized Colorectal Cancer with Computerized Tomography Image Features under Deep Learning

This study aimed to explore the value of abdominal computerized tomography (CT) three-dimensional reconstruction using the dense residual single-axis super-resolution algorithm in the diagnosis of nonperitonealized colorectal cancer (CC). 103 patients with nonperitonealized CC (the lesion was located in the ascending colon or descending colon) were taken as the research subjects. The imagological tumor (T) staging, the extramural depth (EMD) of the cancer tissues, and the extramural vascular invasion (EMVI) grading were analyzed. A dense residual single-axis super-resolution network model was also constructed for enhancing CT images. It was found that the CT images processed using the algorithm were clear, and the peak signal-to-noise ratio (PSNR) and structural similarity (SSIM) were 33.828 dB and 0.856, respectively. In the imagological T staging of CC patients, there were 17 cases in the T3 stage and 68 cases in the T4 stage. With the EMD increasing, the preoperative carcinoembryonic antigen (CEA) highly increased, and the difference was statistically significant (P < 0.05). The postoperative hospital stays of patients were also different with different grades of EMVI. The hospital stay of grade 1 patients (19.45 days) was much longer than that of grade 2 patients (13.19 days), grade 3 patients (15.36 days), and grade 4 patients (14.36 days); the differences were of statistical significance (P < 0.05). It was suggested that CT images under the deep learning algorithm had a high clinical value in the evaluation of T staging, EMD, and EMVI for the diagnosis of CC.

Gastrointestinal stromal tumor in ruptured Meckel's diverticulum located in jejunum caused myelosuppression for a short time: A case report

INTRODUCTION AND IMPORTANCE

Gastrointestinal stromal tumor (GIST) in Meckel's diverticulum (MD) is rare but it seems to be a common phenomenon that GIST triggers MD perforation or rupture; the exact mechanism is unclear. In addition, the location of GIST in perforated or ruptrued MD is most common in ileum, rarely in jejunum. We herein report a GIST in ruptured MD Located in jejunum and severe peritoneal cavity infection leads to myelosuppression.

CASE PRESENTATION

A female patient was admitted to our hospital with "abdominal pain". Physical examination and laboratory tests revealed that the patient was in shock and myelosuppression. Abdominal X-ray photograph and computed tomography indicated perforation of digestive tract. Laparotomy revealed rupture of MD located 90 cm from the Treitz ligament and a tumor was also found in the MD. As the condition is critical, the MD was excisioned from its root and the small bowel gap was closed and repaired. Laboratory indicators showed that myelosuppression was removed 24 h after operation. The pathological findings established a GIST in the MD. The patient was discharged on postoperative day 5 without significant complications.

CLINICAL DISCUSSION

A GIST in ruptured MD Located in jejunum caused the severe peritoneal cavity infection and myelosuppression In a short time, as seen in this case. Failure to recognize the severity of the disease and delay in treatment will endanger the life of the patient.

CONCLUSION

GIST in MD Located in jejunum is very rare, and the rupture of the MD can be life-threatening at any time.

Massive Gastrointestinal Bleeding Due to Jejunal Diverticula in a Community Hospital: A Case Report and Review of Diagnostic and Therapeutic Options

Small bowel diverticula are rare and often asymptomatic. Severe lower gastrointestinal bleeding from jejunal diverticula is rarely reported and, therefore, should be considered a differential diagnosis in all cases of lower gastrointestinal bleeding with nonconclusive gastroscopy and colonoscopy. In this case report, we discuss a case of a 75-year-old male with massive lower gastrointestinal bleeding from jejunal diverticula. Initial gastroscopy did not reveal the source of bleeding. Repeat upper endoscopy with a pediatric colonoscope identified jejunal diverticula as the likely source of bleeding. Angiography identified the site of extravasation, and successful angioembolization was done by interventional radiology.