1
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Agarwal D, Ali I, Shetty V. Jejunal Diverticulosis: An Atypical Lead Point for Small Bowel Volvulus. Cureus 2024; 16:e56125. [PMID: 38618384 PMCID: PMC11015065 DOI: 10.7759/cureus.56125] [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: 12/10/2023] [Indexed: 04/16/2024] Open
Abstract
The occurrence of small intestinal diverticula is relatively infrequent compared to its counterpart in the large bowel. Duodenal diverticula exhibit a significantly higher prevalence within the small intestine compared to jejunoileal diverticula, with a ratio of five to one. The occurrence of jejunoileal diverticula exhibits considerable variability and has been documented to range from 0.5% to 2.3% in radiographic series, while autopsy studies have reported rates as high as 7%. We present the clinical details of a 65-year-old male patient who sought medical attention due to a constellation of symptoms, including abdominal pain, vomiting, and obstipation. After adequate resuscitation with IV fluids and preoperative preparation, the patient was transported to the operating room for an emergency exploratory laparotomy. Multiple jejunal diverticuli were identified in the proximal jejunum at the antimesenteric border, less than three feet from the duodenojejunal (DJ) junction. The terminal ileum was found to be 360° rotated counterclockwise around the small bowel mesentery, causing the small intestine to appear congested; however, after clockwise de-rotation, the small bowel regained its normal color. Adhesiolysis and small bowel decompression were performed, and the patient had an uneventful recovery.
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Affiliation(s)
- Divij Agarwal
- General Surgery, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Iqbal Ali
- General Surgery, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Varun Shetty
- General Surgery, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, IND
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2
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Kurita S, Kitagawa K, Toya N, Kaji M, Yoshioka S, Hiramoto Y, Fujioka S, Takahashi N, Eto K. Transcatheter arterial embolization followed by surgical laparotomy for hemorrhagic shock due to intestinal bleeding: a case report. Surg Case Rep 2022; 8:11. [PMID: 35038053 PMCID: PMC8762533 DOI: 10.1186/s40792-022-01363-3] [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: 10/09/2021] [Accepted: 01/09/2022] [Indexed: 12/04/2022] Open
Abstract
Background Acquired jejunal diverticula are relatively rare conditions. While mostly asymptomatic, they can occasionally cause life-threatening complications requiring surgical treatment. We herein report a case of hemorrhagic shock due to jejunal diverticulum with intestinal amyloidosis that was successfully managed via transcatheter arterial embolization (TAE) and surgery. Case presentation An 80-year-old female presenting with hematochezia and hemorrhagic shock was transferred to our institution. Contrast-enhanced computed tomography revealed extravasation in the small bowel around the upper jejunum. Massive transfusion was performed with subsequently planning for TAE to control bleeding followed by surgical laparotomy to evaluate the ischemic intestine. First, the second jejunal artery was selectively embolized with a 1:3 mixture of N-butyl cyanoacrylate (NBCA) and iodize oil, after which laparotomy was performed. Multiple jejunal diverticula were detected near Treitz’ ligament, and an induration of NBCA was palpable in the nearby mesentery. The intraoperative diagnosis was massive bleeding from acquired jejunal diverticula for which jejunectomy including the nearby diverticulum was performed to prevent future bleeding. Her postoperative course was stable. Histological examination of the specimen revealed several false diverticula with intestinal amyloidosis. Conclusion Hemorrhagic shock due to jejunal diverticulum with intestinal amyloidosis is extremely rare. Combined treatment of TAE and surgical laparotomy appears to be effective, because the bleeding point can be identified by palpation of the embolic material.
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Affiliation(s)
- Sayumi Kurita
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba, 277-8567, Japan.
| | - Kazuo Kitagawa
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba, 277-8567, Japan
| | - Naoki Toya
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba, 277-8567, Japan
| | - Mutsumi Kaji
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba, 277-8567, Japan
| | - Satoshi Yoshioka
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba, 277-8567, Japan
| | - Yuki Hiramoto
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba, 277-8567, Japan
| | - Shuichi Fujioka
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba, 277-8567, Japan
| | - Naoto Takahashi
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba, 277-8567, Japan
| | - Ken Eto
- Department of Surgery, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, 105-8471, Japan
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3
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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: 3] [Impact Index Per Article: 1.5] [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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4
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Wauters L, Clarysse M, Jochmans I, Monbaliu D, Ceulemans LJ, Verbiest A, Miserez M, Lauwers N, Nys W, Pauwels N, Hiele M, Pirenne J, Vanuytsel T. Chronic small intestinal dysmotility presenting as jejunal diverticulosis with refractory malabsorption: role for partial enterectomy? Gut 2022; 71:218-219. [PMID: 33707231 DOI: 10.1136/gutjnl-2021-324385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 12/08/2022]
Affiliation(s)
- Lucas Wauters
- Department of Gastroenterology and Hepatology, Leuven University Hospitals Leuven, Leuven, Flanders, Belgium.,Leuven Intestinal Failure and Transplantation (LIFT), Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Mathias Clarysse
- Leuven Intestinal Failure and Transplantation (LIFT), Leuven University Hospitals Leuven, Leuven, Flanders, Belgium.,Abdominal Transplant Surgery, Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Ina Jochmans
- Leuven Intestinal Failure and Transplantation (LIFT), Leuven University Hospitals Leuven, Leuven, Flanders, Belgium.,Abdominal Transplant Surgery, Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Diethard Monbaliu
- Leuven Intestinal Failure and Transplantation (LIFT), Leuven University Hospitals Leuven, Leuven, Flanders, Belgium.,Abdominal Transplant Surgery, Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Laurens J Ceulemans
- Leuven Intestinal Failure and Transplantation (LIFT), Leuven University Hospitals Leuven, Leuven, Flanders, Belgium.,Thoracic Surgery, Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Astrid Verbiest
- Leuven Intestinal Failure and Transplantation (LIFT), Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Marc Miserez
- Abdominal Surgery, Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Nathalie Lauwers
- Leuven Intestinal Failure and Transplantation (LIFT), Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Wendy Nys
- Leuven Intestinal Failure and Transplantation (LIFT), Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Nelle Pauwels
- Leuven Intestinal Failure and Transplantation (LIFT), Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Martin Hiele
- Department of Gastroenterology and Hepatology, Leuven University Hospitals Leuven, Leuven, Flanders, Belgium.,Leuven Intestinal Failure and Transplantation (LIFT), Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Jacques Pirenne
- Leuven Intestinal Failure and Transplantation (LIFT), Leuven University Hospitals Leuven, Leuven, Flanders, Belgium.,Abdominal Transplant Surgery, Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Tim Vanuytsel
- Department of Gastroenterology and Hepatology, Leuven University Hospitals Leuven, Leuven, Flanders, Belgium .,Leuven Intestinal Failure and Transplantation (LIFT), Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
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5
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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: 2] [Impact Index Per Article: 0.7] [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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6
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Goh B, Harbison A, Sufyan W, Thomas S. Perforated jejunal diverticular disease: an uncommon cause of the acute surgical abdomen. ANZ J Surg 2021; 91:E608-E609. [PMID: 33497515 DOI: 10.1111/ans.16618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/21/2020] [Accepted: 01/06/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Barnabas Goh
- Department of General Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Annabelle Harbison
- Department of General Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Wajiha Sufyan
- Department of General Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Sabu Thomas
- Department of General Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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7
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Sammartino F, Selvaggio I, Montalto GM, Pasecinic C, Dhimolea S, Krizzuk D. Acute Abdomen in a 91-Year-Old Male due to Perforated Jejunal Diverticulitis. Case Rep Gastroenterol 2020; 14:598-603. [PMID: 33362446 DOI: 10.1159/000509529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/16/2020] [Indexed: 11/19/2022] Open
Abstract
Non-Meckel small intestine diverticular disease is a rare and mostly asymptomatic condition. However, rare cases of acute and emergent complications bear a high mortality rate. We report a case of a 91-year-old male that presented with an acute abdomen due to perforated jejunal diverticulitis. A review of the literature and key points of the condition are depicted. Although jejunal diverticulosis is rare, it must be considered in the differential diagnosis, especially in the elderly with signs of ambiguous abdominal pain and peritonitis.
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8
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ÇAKIR M. Giant Jejunal Diverticula Causing Pseudoobstruction. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2020. [DOI: 10.33706/jemcr.744147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Romera-Barba E, Pastor SG, Navarro García MI, Torregrosa Pérez NM, Sánchez Pérez A, Vazquez-Rojas JL. Jejunal diverticulosis: A rare cause of intestinal obstruction. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 40:399-401. [PMID: 27270086 DOI: 10.1016/j.gastrohep.2016.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 04/27/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Elena Romera-Barba
- Servicio de Cirugía General, Hospital General Universitario Santa Lucía, Cartagena, Murcia, España.
| | - Silvia Gálvez Pastor
- Servicio de Cirugía General, Hospital General Universitario Santa Lucía, Cartagena, Murcia, España
| | | | | | - Ainhoa Sánchez Pérez
- Servicio de Cirugía General, Hospital General Universitario Santa Lucía, Cartagena, Murcia, España
| | - José Luis Vazquez-Rojas
- Servicio de Cirugía General, Hospital General Universitario Santa Lucía, Cartagena, Murcia, España
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10
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Téoule P, Birgin E, Zaltenbach B, Kähler G, Wilhelm TJ, Kienle P, Rückert F. A Retrospective, Unicentric Evaluation of Complicated Diverticulosis Jejuni: Symptoms, Treatment, and Postoperative Course. Front Surg 2015; 2:57. [PMID: 26618161 PMCID: PMC4643121 DOI: 10.3389/fsurg.2015.00057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/26/2015] [Indexed: 11/13/2022] Open
Abstract
Background In contrast to the diverticulosis of the colon, jejunal diverticulosis is a rare condition. The incidence is 0.06–5% in large autopsy series. Complicated diverticulosis jejuni (CDJ) often presents with unspecific symptoms. Therefore, diagnosis is often a challenging process and due to the clinical rarity generally valid recommendation of perioperative management does not exist. Patients and methods We considered only patients who were operated in our center between April 2007 and August 2014. Patients were identified by data bank search via International Statistical Classification of Diseases and Related Health Problems diagnosis code K57.10. Data were manually screened, and patients with Meckel’s and duodenal diverticula were excluded from this study. Eleven consecutive patients with CDJ were finally included in this study. We analyzed symptoms, diagnostic procedures, surgical treatment, and postoperative morbidity and mortality. Results The median age of our patients was 76 years (range: 34–87). CDJ presented most frequently as intestinal bleeding or as diverticulitis. Clinical symptoms were unspecific abdominal pain, hematemesis or melena, ileus, nausea, and emesis as well as patients with acute abdomen. Esophagogastroduodenoscopies confirmed CDJ in two of the three patients. An abdominal computed tomography scan only helped to diagnose CDJ in two of the 10 patients. Eight (72.7%) patients received an open segmental resection with primary anastomosis. In three (27.3%) cases, a reoperation was necessary. Overall morbidity rate was 45.5%, and perioperative mortality was 9.1%. Conclusion Due to the acute character of the disease, patients with CDJ are seriously ill. To diagnose patients with CDJ remains challenging as diagnostic investigations are usually not helpful in confirming the diagnosis. Still, diagnosis of CDJ is most frequently confirmed intraoperatively.
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Affiliation(s)
- Patrick Téoule
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University , Mannheim , Germany
| | - Emrullah Birgin
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University , Mannheim , Germany
| | - Benjamin Zaltenbach
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University , Mannheim , Germany
| | - Georg Kähler
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University , Mannheim , Germany
| | - Torsten J Wilhelm
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University , Mannheim , Germany
| | - Peter Kienle
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University , Mannheim , Germany
| | - Felix Rückert
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University , Mannheim , Germany
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11
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Mansoori B, Delaney CP, Willis JE, Paspulati RM, Ros PR, Schmid-Tannwald C, Herrmann KA. Magnetic resonance enterography/enteroclysis in acquired small bowel diverticulitis and small bowel diverticulosis. Eur Radiol 2015; 26:2881-91. [PMID: 26597545 DOI: 10.1007/s00330-015-4098-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 08/10/2015] [Accepted: 10/28/2015] [Indexed: 12/27/2022]
Abstract
PURPOSE Small bowel (SB) diverticulosis is a rare disorder that may entail serious complications, including SB diverticulitis. Both are often missed in imaging. Magnetic resonance enterography/enteroclysis (MRE) is increasingly used to assess SB disease; awareness of the appearance of SB diverticulitis is essential to ensure appropriate management. Our aim was to systematically describe imaging characteristics of SB diverticulosis and diverticulitis in MRE. METHODS This retrospective, HIPAA-compliant study identified 186 patients with suspected SB diverticulosis/diverticulitis in medical databases of two tertiary medical centres between 2005 and 2011. Patients with surgically confirmed diagnoses of SB diverticulosis/diverticulitis were included. Two observers analyzed MR images for the presence, location, number, and size of diverticula, wall thickness, and mural and extramural patterns of inflammation. RESULTS Seven patients were recruited. MRI analysis showed multiple diverticula in all (100 %). Diverticular size ranged from 0.5 to 6 cm. Prevalence of diverticula was higher in the proximal than the distal SB (jejunum 86 %, ileum 57 %, distal ileum43%). Diverticulitis occurred in 3/7 patients (43 %) showing asymmetric bowel wall thickening and focal mesenteric inflammation. CONCLUSION SB diverticulitis demonstrates characteristic MRE imaging features to distinguish this rare disorder from more common diseases. Asymmetric, focal mesenteric and mural inflammation and presence of multiple diverticula are keys to diagnosis. KEY POINTS • Small bowel diverticulosis and diverticulitis is rare and often missed in imaging • Acquired small bowel diverticula are variable in size and number • Small bowel diverticulitis demonstrates characteristic features on MR enterography/enteroclysis • A focal or segmental asymmetric small bowel inflammation should prompt the search for diverticula.
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Affiliation(s)
- Bahar Mansoori
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Conor P Delaney
- Department of Surgery, Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Joseph E Willis
- Department of Pathology, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Raj M Paspulati
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH, USA.,Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Pablo R Ros
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH, USA.,Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | | | - Karin A Herrmann
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH, USA. .,Department of Radiology, Case Western Reserve University, Cleveland, OH, USA. .,University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
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12
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Igwe PO, Ray-Offor E, Allison AB, Alufohai EF. Volvulus complicating jejunal diverticulosis: A case report. Int J Surg Case Rep 2015; 9:61-4. [PMID: 25728670 PMCID: PMC4392326 DOI: 10.1016/j.ijscr.2015.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/08/2015] [Accepted: 02/09/2015] [Indexed: 11/26/2022] Open
Abstract
Jejunal diverticular disease is rare in Africa. Our patient presented with small bowel obstruction due to volvulus. Other complications are discussed.
Introduction Diverticular disease is uncommon among Africans though increasing number of cases is now being reported, mainly of colonic diverticulosis. This condition afflicts all parts of the gastrointestinal tract but commonly the colon. Jejunal diverticula are rare, usually asymptomatic but may lead to an acute abdomen. Case presentation A 68 year old female trader, who was referred from a peripheral center with insidious onset of severe colicky, generalized abdominal pain, repeated vomiting of recently ingested meal, no hematemesis. There was constipation and abdominal distension. The working diagnosis was dynamic intestinal obstruction of small bowel origin. She had emergency exploratory laparotomy following resuscitation. The findings were: volvulus of the jejunum and multiple jejunal diverticula. A resection of 80 cm of the jejunum with most of the diverticula involved in the torsion was done with an end-to-end anastomosis of the jejunum. Her out-patient follow-up has been uneventful. Discussion Jejunal diverticular disease is rare in Africa. Our patient presented with small bowel obstruction due to volvulus. Other complications are discussed. Conclusion Intestinal obstruction from diverticular disease is not always of colonic origin. It can occur in the jejunum.
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Affiliation(s)
- P O Igwe
- Department of Surgery, University of Port Harcourt Teaching Hospital, Alakahia, Rivers State, Nigeria.
| | - E Ray-Offor
- Department of Surgery, University of Port Harcourt Teaching Hospital, Alakahia, Rivers State, Nigeria
| | - A B Allison
- Department of Surgery, University of Port Harcourt Teaching Hospital, Alakahia, Rivers State, Nigeria
| | - E F Alufohai
- Department of Surgery, University of Port Harcourt Teaching Hospital, Alakahia, Rivers State, Nigeria
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13
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Lee BJ, Kumar P, Van den Bosch R. Jejunal diverticula: a rare cause of life-threatening gastrointestinal bleeding. J Surg Case Rep 2015; 2015:rju150. [PMID: 25600131 PMCID: PMC4297890 DOI: 10.1093/jscr/rju150] [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: 12/05/2022] Open
Abstract
Jejunal diverticula are rare and the condition remains mostly asymptomatic. However, they can present with vague chronic abdominal symptoms and, in some cases, acute life-threatening complications, such as gastrointestinal (GI) bleeding, bowel obstruction and perforation. We present a case of an adult male who presented with life-threatening GI bleeding secondary to jejunal diverticular disease. Whilst there are undoubtedly more common causes of GI bleeding, this case demonstrates that jejunal diverticular disease should remain on the differential diagnosis and investigations to confirm the diagnosis should be considered. However, despite investigations, the diagnosis may remain elusive and in patients with on-going bleeding, laparotomy and surgical resection is currently the treatment of choice.
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Affiliation(s)
- Beom Jun Lee
- Department of General Surgery, Timaru Hospital, South Canterbury, New Zealand
| | - Prashant Kumar
- Department of General Surgery, Timaru Hospital, South Canterbury, New Zealand
| | - Rene Van den Bosch
- Department of General Surgery, Timaru Hospital, South Canterbury, New Zealand
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14
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Emergency surgery for metastatic melanoma. Int J Surg Oncol 2014; 2014:987170. [PMID: 25530876 PMCID: PMC4228804 DOI: 10.1155/2014/987170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 10/14/2014] [Indexed: 12/28/2022] Open
Abstract
Visceral metastases from malignant melanoma (stage M1c) confer a very poor prognosis, as documented on the most recent revised version of the TNM/AJCC staging system. Emergency surgery for intra-abdominal complications from the disease is rare. We report on our 5-year single institution experience with surgical management of metastatic melanoma to the viscera in the emergent setting. From 2009 to 2013, 14 patients with metastatic melanoma were admitted emergently due to an acute abdomen. Clinical manifestations encompassed intestinal obstruction and bleeding. Surgical procedures involved multiple enterectomies with primary anastomoses in 8 patients, and one patient underwent splenectomy, one adrenalectomy, one right colectomy, one gastric wedge resection, one gastrojejunal anastomosis, and one transanal debulking, respectively. The 30-day mortality was 7 percent. Median follow-up was 14 months. Median overall survival was 14 months. Median disease free survival was 7.5 months. One-year overall survival was 64.2 percent and 2-year overall survival was 14.2 percent. Emergency surgery for metastatic melanoma to the viscera is rare. Elective curative surgery combined with novel cytotoxic systemic therapies is under investigation in an attempt to grant survival benefit in melanoma patients with visceral disease.
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15
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Kim PS, Jung EJ, Bang HY. Small bowel diverticulosis in patient with early gastric cancer. Ann Surg Treat Res 2014; 87:209-12. [PMID: 25317417 PMCID: PMC4196433 DOI: 10.4174/astr.2014.87.4.209] [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: 12/13/2013] [Revised: 01/07/2014] [Accepted: 01/14/2014] [Indexed: 11/30/2022] Open
Abstract
Jejunal and ileal diverticula are rare in adults. Duodenal diverticula are five times more prevalent than jejunoileal diverticula. Most patients are asymptomatic. However, chronic symptoms including intermittent abdominal pain, flatulence, diarrhea and constipation are seen in 10%-30% of patients. Gastric cancer is the second most common cancer in South Korea and here we report a case of early gastric cancer with multiple duodenal and jejunal diverticula. A 67-year-old woman was admitted to Konkuk University Medical Center with chronic diarrhea and weight loss of 19 kg over 2 months. Following gastroduodenoscopy, we identified adenocarcinoma of the lower body of the stomach. On abdominopelvic computed tomography, diverticula of duodenum and jejunum were found. Patient underwent distal gastrectomy and gastroduodenostomy with lymphadenectomy. She was discharged on the tenth postoperative day without complications.
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Affiliation(s)
- Pyeong Su Kim
- Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Eun-Joo Jung
- Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Ho Yoon Bang
- Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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16
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Motos Micó J, Velasco Albendea FJ, Ferrer Márquez M, Ferrer Ayza M, Rosado Cobián R. Abdomen agudo secundario a diverticulitis yeyunal perforada. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 37:467-8. [DOI: 10.1016/j.gastrohep.2013.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 11/27/2013] [Accepted: 11/29/2013] [Indexed: 10/25/2022]
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17
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An unusual cause of abnormal liver enzymes, leukocytosis, and right upper quadrant abdominal pain. Clin Gastroenterol Hepatol 2014; 12:A31-2. [PMID: 24681083 DOI: 10.1016/j.cgh.2014.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 03/13/2014] [Accepted: 03/13/2014] [Indexed: 02/07/2023]
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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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19
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Kirshtein B, Perry ZH, Klein J, Laufer L, Sion-Vardi N. Giant enterolith in ileal diverticulum following ileoplastic bladder augmentation. Int J Surg Case Rep 2013; 4:385-7. [PMID: 23500738 DOI: 10.1016/j.ijscr.2013.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 01/23/2013] [Accepted: 01/24/2013] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION When adhesions, internal hernias, malignant intra- and retro-peritoneal neoplasms are excluded in patients presenting with new onset constipation and abdominal mass appearance after previous abdominal surgery, other causes must be considered. PRESENTATION OF CASE Giant enteroliths formed within ileal diverticula in the site of small bowel anastomosis may extrude and produce a palpable abdominal lump. Recent experience with such a patient is the basis of this report. DISCUSSION Ileal diverticula with interior enteroliths may be suspected in patients presenting with an abdominal lump following previous small bowel resection. CONCLUSION Open or laparoscopic assisted surgical resection of the involved segment is the treatment of choice.
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Affiliation(s)
- Boris Kirshtein
- Department of Surgery "A", Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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20
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Pak A, Demuro JP, Botros DG, Bohrer SL. A case of obstruction due to jejunoileal diverticula. J Gastrointest Surg 2011; 15:2108-10. [PMID: 21544677 DOI: 10.1007/s11605-011-1548-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 04/18/2011] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The objective of this study is to discuss the presentation and diagnosis of a complicated jejunoileal diverticuli. CASE REPORT The case of a 94-year-old woman with small bowel obstruction secondary to an impacted enterolith from a jejunoileal diverticulum is presented to illustrate the clinical picture and radiographic findings of complicated small bowel diverticula.
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Affiliation(s)
- Aimee Pak
- Department of Surgery, Winthrop University Hospital, NY 11501, USA.
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21
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Bosanquet DC, Williams N, Lewis MH. Acquired small bowel diverticular disease: a review. Br J Hosp Med (Lond) 2010; 71:552-5. [DOI: 10.12968/hmed.2010.71.10.78937] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- DC Bosanquet
- Department of Surgery, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant CF72 8XR
| | - N Williams
- Department of Surgery, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant CF72 8XR
| | - MH Lewis
- Department of Surgery, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant CF72 8XR
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22
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Tan KK, Liu JZ, Ho CK. Emergency surgery for jejunal diverticulosis: our experience and review of literature. ANZ J Surg 2010; 81:358-61. [PMID: 21518186 DOI: 10.1111/j.1445-2197.2010.05480.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Jejunal diverticulosis is a rare entity and is often asymptomatic. However, some of its complications may require acute surgical intervention. This study was performed to evaluate the presentation and outcome of patients who underwent urgent surgery for complicated jejunal diverticulosis. METHODS A retrospective review of all patients who underwent emergency surgery for complicated jejunal diverticulosis from November 2005 to December 2008 was performed. RESULTS Six cases of complicated jejunal diverticulosis required urgent surgery during the study period. Three patients presented with acute abdomen from perforated jejunal diverticulum. Preoperative computed tomographic (CT) scans were useful in localizing the source of sepsis. One patient died from the subsequent complications. The other three patients presented with massive lower gastrointestinal haemorrhage for which CT angiography was able to localize the source of haemorrhage in two of them. Small bowel resection was then performed and all three were discharged well eventually. CONCLUSION Though rare, jejunal diverticulosis can present with several life-threatening complications that mandates immediate surgery. While the surgical procedure may be technically simple, achieving the accurate preoperative diagnosis is often fraught with challenges. CT scan could prove invaluable in the management if the situation permits.
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Affiliation(s)
- Ker-Kan Tan
- Digestive Disease Centre, Department of General Surgery, Tan Tock Seng Hospital, Singapore.
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23
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Pate A, Cheung M, Agarwala A, Chendrasekhar A. Jejunal Diverticulosis. Am Surg 2010. [DOI: 10.1177/000313481007600841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Amy Pate
- Department of Surgery Wyckoff Heights Medical Center Brooklyn, New York
| | - Mathew Cheung
- Department of Surgery Wyckoff Heights Medical Center Brooklyn, New York
| | - Ashish Agarwala
- Department of Surgery Wyckoff Heights Medical Center Brooklyn, New York
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Butler JS, Collins CG, McEntee GP. Perforated jejunal diverticula: a case report. J Med Case Rep 2010; 4:172. [PMID: 20525399 PMCID: PMC2900277 DOI: 10.1186/1752-1947-4-172] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2009] [Accepted: 06/07/2010] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Jejunal diverticula are rare and are usually asymptomatic. However, they may cause chronic non-specific symptoms or rarely lead to an acute presentation. CASE PRESENTATION We report the case of an 82-year-old Caucasian woman presenting with a one-day history of generalized abdominal pain, with three episodes of vomiting. An abdominal X-ray displayed multiple dilated loops of the small bowel. A subsequent computed tomography scan of the abdomen and pelvis revealed a thickening of the duodenum and dilatation of the proximal jejunum. Multiple small bowel diverticula were identified with surrounding pockets of free air adjacent to the jejunal diverticula suggestive of a small bowel perforation. Our patient underwent a laparotomy, which identified multiple jejunal diverticula with two pinhole jejunal perforations and associated fecal contamination. The perforations were repaired with primary closure and extensive washout was performed. CONCLUSION Jejunal diverticulosis in the elderly can lead to significant morbidity and mortality and so should be suspected in those presenting with crampy abdominal pain and altered bowel habits.
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Affiliation(s)
- Joseph S Butler
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
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Abstract
Terminal ileum diverticulitis is a very rare disease that may lead to an acute abdomen mimicking appendicitis. Because of its rarity, an optimal treatment for this disease has not been established yet. In this study, we evaluated the clinical features and outcomes of nonoperative management of terminal ileum diverticulitis, including suspected perforation. From 2000 to 2007, 346 patients were treated for acute symptomatic right-sided diverticulitis. Radiographic evaluation revealed that nine patients (2.6%) had terminal ileum diverticulitis. All patients presented with pain in the right lower quadrant. The clinical features and outcomes, including recurrence, were evaluated from a collected database and by phone interview. The average age of the patients was 43.7 years. Radiographic imaging was used to diagnose diverticulitis in all patients. Two of nine patients had suspected perforated diverticulitis, and three patients had multiple diverticula. Nonoperative management was successfully carried out on these patients. The average hospital stay was 8 days and the duration of antibiotic treatment was 6.4 days. The median follow-up was 36 months, and patients showed no recurrence within this interval. Nonoperative management may be feasible to treat terminal ileum diverticulitis.
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Affiliation(s)
- Hyoung-Chul Park
- From the Department of Surgery, Hallym University College of Medicine, Anyang, Korea
| | - Bong Hwa Lee
- From the Department of Surgery, Hallym University College of Medicine, Anyang, Korea
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