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Comune R, Liguori C, Guida F, Cozzi D, Ferrari R, Giardina C, Iacobellis F, Galluzzo M, Tonerini M, Tamburrini S. Left side jejunal diverticulitis: US and CT imaging findings. Radiol Case Rep 2024; 19:2785-2790. [PMID: 38680749 PMCID: PMC11046047 DOI: 10.1016/j.radcr.2024.04.003] [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: 02/07/2024] [Revised: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 05/01/2024] Open
Abstract
Small bowel jejunoileal diverticulosis is an uncommon and usually asymptomatic condition. Complications may occur such as acute diverticulitis including infection or perforation, bleeding, small bowel obstruction and volvulus. Herein we report a case of a 76 years-old woman with acute left side abdominal pain and tenderness. A clinical suspected diagnosis of colonic diverticulitis was formulated. She underwent Ultrasound that revealed a collapsed small bowel loop with a large sac-like out-pouching lesion with mixed content (fluid and pockets of air) associated to hyperechogenicity of perilesional fat. Because of the atypical US findings, the patient underwent abdominopelvic CT that confirmed that the large sac-like out-pouching was a jejunal inflamed diverticulum. The patient underwent emergency surgery. Radiologist should be aware of imaging findings of jejunoileal diverticulitis in order to achieve a prompt diagnosis.
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Affiliation(s)
- Rosita Comune
- Division of Radiology, "Università degli Studi della Campania Luigi Vanvitelli", Naples, Italy
| | - Carlo Liguori
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Naples, Italy
| | - Francesco Guida
- Department of General and Emergency Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Riccardo Ferrari
- Department of Emergency Radiology, San Camillo Forlanini Hospital, Rome, Italy
| | - Claudio Giardina
- Department of Radiology, ASP of Messina-Hospital of Taormina, Messina, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Via A. Cardarelli 9, Napoli, Italy
| | - Michele Galluzzo
- Department of Emergency Radiology, San Camillo Forlanini Hospital, Rome, Italy
| | - Michele Tonerini
- Department of Emergency Radiology, Cisanello Hospital, Via Cisanello, Pisa, Italy
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2
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Barnard P, Wilson K. Complicated jejunal diverticulitis with small bowel obstruction due to enterolith: A case report. Int J Surg Case Rep 2023; 111:108896. [PMID: 37812959 PMCID: PMC10568270 DOI: 10.1016/j.ijscr.2023.108896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Small bowel diverticular disease (DD) is encountered and managed much less frequently than colonic DD, leading to a significantly less developed body of evidence for managing small bowel diverticulum and its associated complications. CASE PRESENTATION This case report discusses a rare occurrence of simultaneous perforated jejunal diverticulitis and mechanical small bowel obstruction (SBO) due to a migrating diverticular enterolith. The patient's condition was ultimately managed operatively through laparoscopically assisted small bowel resection. CLINICAL DISCUSSION A review of the literature reveals only eight reported cases of jejunal diverticulitis with simultaneous enterolith obstruction. All cases were managed operatively, with approaches including small bowel resection encompassing both pathologies, milking the enterolith back to the diverticulitis site and resecting en bloc to avoid extensive resection, or enterotomy and enterolith retrieval. CONCLUSION The prevalence of small bowel diverticular disease is increasing, and as a result, clinicians may encounter more complications associated with this condition in the future. This case highlights the importance of considering alternate complications of small bowel DD.
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Affiliation(s)
- Paige Barnard
- Sunshine Coast University Hospital (SCUH), 6 Doherty Street, Birtinya, QLD 4575, Australia.
| | - Katherine Wilson
- Sunshine Coast University Hospital (SCUH), 6 Doherty Street, Birtinya, QLD 4575, Australia
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3
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Matli VVK, Thoguluva Chandrasekar V, Campbell JL, Karanam C, Jaganmohan S. Jejunal Diverticulitis: A Rare Diverticular Disease of the Bowel. Cureus 2022; 14:e21386. [PMID: 35070587 PMCID: PMC8766225 DOI: 10.7759/cureus.21386] [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] [Accepted: 01/18/2022] [Indexed: 11/13/2022] Open
Abstract
Diverticulosis is an out-pocketing of the bowel wall that can affect the small bowel through the large bowel. Small bowel diverticulosis is rare and not as common as colonic diverticulosis, which is an important diagnosis for hospitalizations. Moreover, jejunal diverticulosis is rare among cases of small bowel diverticulosis. Jejunal diverticulitis is one of the complications of jejunal diverticulosis that can be conservatively managed with antibiotics instead of surgery. We report a case of a 41-year-old African American man who presented with vague epigastric pain and was diagnosed with adhesive jejunal diverticulitis upon contrast-enhanced computed tomography of the abdomen. The patient did not develop any life-threatening complications such as perforation or peritonitis, and recovered after conservative management with antibiotics. Adhesive jejunal diverticulitis with fat stranding was the distinctive finding in our patient, as he might have had multiple asymptomatic episodes. Initial diagnostic modalities include radiography and contrast-enhanced computed tomography. Enteroclysis is the most reliable and accurate diagnostic modality, but is not available in all urgent settings. Recently, endoscopy has replaced radiological studies. Conservative management is adequate for uncomplicated cases of jejunal diverticulitis. However, surgical intervention is required in most cases of complicated jejunal diverticulosis, or mortality rates will be high.
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4
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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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5
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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: 0] [Impact Index Per Article: 0] [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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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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7
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Leigh N, Sullivan BJ, Anteby R, Talbert S. Perforated jejunal diverticulitis: a rare but important differential in the acute abdomen. Surg Case Rep 2020; 6:162. [PMID: 32632508 PMCID: PMC7338329 DOI: 10.1186/s40792-020-00929-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/29/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Diverticulosis of the small bowel is rare and, in most cases, discovered incidentally. However, diverticulitis and other complications are important to consider in the differential of an acute abdomen, especially in the elderly population. CASE PRESENTATION The patient was a 59-year-old female who presented with acute lower abdominal pain progressing to peritonitis. Computed tomography scan showed a large inflamed and perforated diverticulum on the mesenteric side of the jejunum. Exploratory laparotomy revealed a dilated proximal jejunum with a 5-cm inflamed and perforated mesenteric diverticulum. A small bowel resection with primary anastomosis was performed. CONCLUSIONS Jejunal diverticulitis remains a diagnostic challenge. Although uncommon, owing to its high mortality rate, it is an important clinical entity to consider and requires timely management.
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Affiliation(s)
- Natasha Leigh
- Department of General Surgery, Icahn School of Medicine at Mount Sinai St. Luke’s Roosevelt Hospital, 425 West 59th Street, Suite 7B, New York, NY 10019 USA
| | - Brianne J. Sullivan
- Department of General Surgery, Icahn School of Medicine at Mount Sinai St. Luke’s Roosevelt Hospital, 425 West 59th Street, Suite 7B, New York, NY 10019 USA
| | - Roi Anteby
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Susan Talbert
- Department of General Surgery, Icahn School of Medicine at Mount Sinai St. Luke’s Roosevelt Hospital, 425 West 59th Street, Suite 7B, New York, NY 10019 USA
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8
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Bellio G, Kurihara H, Zago M, Tartaglia D, Chiarugi M, Coppola S, Biloslavo A, de Manzini N. Jejunoileal diverticula: a broad spectrum of complications. ANZ J Surg 2020; 90:1454-1458. [PMID: 32627327 DOI: 10.1111/ans.16128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 05/19/2020] [Accepted: 06/14/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Small bowel diverticula are a rare condition occurring mainly in the elderly. They can be isolated or multiple and can involve the duodenum, jejunum and ileum. Acute complications are extremely rare, with an aspecific pattern of symptoms. The aim of the study is to report the different patterns of presentation of patients with complicated jejunoileal diverticula. METHODS This is a retrospective descriptive study on a consecutive series of patients admitted for complicated jejunoileal diverticula in four Italian surgical departments between 2012 and 2019. Complications included acute diverticulitis, bleeding, perforation and intestinal obstruction. Patients presenting with complicated duodenal or Meckel's diverticula were not included. RESULTS Twenty-six patients were enrolled. The median age was 77 (46-94) years. Abdominal pain, fever and nausea/vomiting were the most frequent symptoms at presentation. Abdominal computed tomography (CT) was diagnostic in 35% of patients. Ten (38%) patients had bowel perforation, nine (35%) acute diverticulitis, five (19%) bowel obstruction and two (8%) had intestinal bleeding. Twenty-one (81%) patients underwent surgery, two (8%) were managed by CT-guided drainage of collections and three (11%) were treated with antibiotics. One patient died post-operatively. The median hospital stay was 9 (5-62) days. CONCLUSION Acutely complicated jejunoileal diverticula are infrequent, but a strong suspect should be raised whenever elderly patients are admitted for unspecific abdominal pain with a non-diagnostic CT scan. Conservative management may be offered in very selected cases if a diagnosis is obtained, but in most instances, surgery is both diagnostic and therapeutic.
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Affiliation(s)
- Gabriele Bellio
- Department of General Surgery, Cattinara Hospital, Trieste, Italy
| | - Hayato Kurihara
- Emergency Surgery and Trauma Unit, Department of Surgery, Humanitas Clinical and Research Center, Milan, Italy
| | - Mauro Zago
- Department of General Surgery, Minimally Invasive Surgery Unit, San Pietro General Hospital, Bergamo, Italy
| | - Dario Tartaglia
- Department of Emergency Surgery, Cisanello Hospital, Pisa, Italy
| | - Massimo Chiarugi
- Department of Emergency Surgery, Cisanello Hospital, Pisa, Italy
| | - Sara Coppola
- Department of General Surgery, Minimally Invasive Surgery Unit, San Pietro General Hospital, Bergamo, Italy
| | - Alan Biloslavo
- Department of General Surgery, Cattinara Hospital, Trieste, Italy
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9
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Koli D, Vats M, Upreti HV. Perforated isolated jejunal diverticula: a rare cause of acute abdomen. Clin J Gastroenterol 2020; 13:728-731. [PMID: 32524464 DOI: 10.1007/s12328-020-01148-x] [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: 03/25/2020] [Accepted: 05/23/2020] [Indexed: 12/01/2022]
Abstract
CASE REPORT A 45-year-old female presented to the surgery emergency department with complaints of pain in the whole abdomen, vomiting and non-passage of flatus and stools for the past one day. Physical examination revealed tachycardia with a normal blood pressure. The abdomen showed diffuse tenderness and guarding and bowel sounds were absent. After appropriate fluid resuscitation, the patient underwent a non-contrast computed tomography, which showed intra-abdominal free air. She was then prepared for exploratory laparotomy. Intraoperatively, three jejunal diverticula were identified at the mesenteric side, with perforation of the distal two. Segmental resection of the jejunum, including three diverticula, with primary end-to-end anastomosis was performed. Histopathology report confirmed the diagnosis of jejunal diverticula. CONCLUSION Jejunal diverticula are extremely rare and are usually asymptomatic. However, such presentation warrants their inclusion under the differential diagnosis of acute abdomen, albeit lower down the order. Isolated jejunal diverticular perforation is a rare complication and may present as a surprise intraoperative finding to the operating surgeon.
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Affiliation(s)
- Davinder Koli
- Department of General Surgery, Maulana Azad Medical College and Lok Nayak Hospital, 9725/15 Katra Nanak Chand, Kishan Ganj, New Delhi, India.
| | - Manu Vats
- Department of General Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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10
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Aispuro IO, Yazzie NP. Diverticulitis of isolated jejunal diverticulum complicated by small bowel obstruction secondary to de novo enterolith formation. J Surg Case Rep 2019; 2019:rjz151. [PMID: 31110655 PMCID: PMC6521685 DOI: 10.1093/jscr/rjz151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/20/2019] [Accepted: 04/25/2019] [Indexed: 12/15/2022] Open
Abstract
Jejunoileal diverticula (JD) are an uncommon condition most prevalent in the sixth and seventh decade of life. Although mostly asymptomatic, JD can be complicated by perforation, diverticulitis, abscess, bleeding, fistula, and small bowel obstruction (SBO) secondary to enterolith formation. There are a limited number of cases describing JD complicated by SBO secondary to enterolith formation. Most of these cases are not associated with diverticulitis and multiple JD are present in all but one previously reported case. We present a case of diverticulitis of a large, isolated jejunal diverticulum complicated by de novo enterolith-induced SBO initially diagnosed as intussusception based on computerized tomography (CT) imaging. Our main objective is to increase awareness that isolated JD are not as readily evident on imaging as cases presenting with multiple JD, but nevertheless should be considered as possible etiology of acute abdomen.
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Affiliation(s)
- Ivan O Aispuro
- The University of Arizona College of Medicine—Tucson, AZ 85724, USA
| | - Nazhone P Yazzie
- Tsehootsooi Medical Center—Fort Defiance, AZ 86504, USA
- Correspondence address. Tsehootsooi Medical Center—Fort Defiance, AZ 86504, USA. Tel: +(928) 729-8000; Fax: +(928) 729-8268; E-mail:
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11
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Lebert P, Ernst O, Zins M. Acquired diverticular disease of the jejunum and ileum: imaging features and pitfalls. Abdom Radiol (NY) 2019; 44:1734-1743. [PMID: 30758535 DOI: 10.1007/s00261-019-01928-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To present radiological aspects of jejunoileal diverticulosis and its complications. RESULTS Jejunoileal diverticulosis is a relatively rare and underestimated condition, which mostly affects the elderly. It is frequently asymptomatic but it can lead to significant complications requiring surgical treatment. Jejunoileal diverticulosis is far less common than colonic diverticulosis. Acquired small bowel diverticula are often numerous but the complication rate is low. Acute diverticulitis is the most frequent complication; its classic presentation involves the jejunum and is often non-severe. Diverticular hemorrhage is the second most common complication; CT scan examination is essential to determine the accurate topography of the pathological diverticula. Small bowel obstruction can occur through several mechanisms: adhesions, enterolith, and intussusception. Extra-intestinal gas without perforation and "pseudo-ischemic" appearance are non-pathological conditions that are important to diagnose in order to avoid surgery. CONCLUSION Jejunoileal diverticulosis usually does not show any symptoms but can lead to diagnostic challenges requiring evaluation by CT. CT scan signs of these complications and some pitfalls must be known.
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Affiliation(s)
- P Lebert
- Department of Digestive Diagnostic and Interventional Radiology, University Hospital Claude Huriez - Regional University Hospital Center, rue Michel Polonowski, 59037, Lille Cedex, France.
| | - O Ernst
- Department of Digestive Diagnostic and Interventional Radiology, University Hospital Claude Huriez - Regional University Hospital Center, rue Michel Polonowski, 59037, Lille Cedex, France
| | - M Zins
- Department of Radiology, Fondation Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75674, Paris, France
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12
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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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13
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Daneel L, Kariappa S. Migrating faecolith: an unusual case of small bowel obstruction. ANZ J Surg 2018; 89:E456-E457. [PMID: 30208506 DOI: 10.1111/ans.14748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/21/2018] [Accepted: 05/30/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Lauren Daneel
- Department of Surgery, Sutherland Hospital, Sydney, New South Wales, Australia
| | - Sanjay Kariappa
- Department of Surgery, Sutherland Hospital, Sydney, New South Wales, Australia
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14
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Spartalis E, Garmpis N, Spartalis M, Damaskos C, Moris D, Athanasiou A, Gkolfakis P, Korkolopoulou P, Dimitroulis D, Mantas D. Rare Coexistance of Ileal Diverticulosis, Crohn's Disease and Small Bowel Adenocarcinoma: Report of a Case. ACTA ACUST UNITED AC 2017; 32:191-195. [PMID: 29275319 DOI: 10.21873/invivo.11224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND/AIM Adenocarcinoma is one of the most common malignant tumors of the small intestine complicating Crohn's disease. However, the coexistence of both conditions with diverticulosis of small bowel in young age makes this coincidence rare and clinical diagnosis very difficult. CASE REPORT We report a case of a woman admitted to our Department with acute abdominal pain and fever. The surgical and histological investigation, revealed a rare coexistence that has never been mentioned in the published medical literature. CONCLUSION Ileal diverticulosis is not frequent and often asymptomatic as well as adenocarcinoma of the small bowel. In this case, those diseases along with Crohn's disease led the patient to acute symptoms.
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Affiliation(s)
- Eleftherios Spartalis
- Second Department of Propaedeutic Surgery, Medical School, "Laikon" General Hospital, University of Athens, Athens, Greece
| | - Nikolaos Garmpis
- Second Department of Propaedeutic Surgery, Medical School, "Laikon" General Hospital, University of Athens, Athens, Greece
| | - Michael Spartalis
- Second Department of Propaedeutic Surgery, Medical School, "Laikon" General Hospital, University of Athens, Athens, Greece
| | - Christos Damaskos
- Second Department of Propaedeutic Surgery, Medical School, "Laikon" General Hospital, University of Athens, Athens, Greece
| | - Demetrios Moris
- Department of Surgery, The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH, U.S.A
| | - Antonios Athanasiou
- Department of Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, U.K
| | - Paraskevas Gkolfakis
- Hepatogastroenterology Unit, Medical School, "Attikon" General Hospital, University of Athens, Athens, Greece
| | | | - Dimitrios Dimitroulis
- Second Department of Propaedeutic Surgery, Medical School, "Laikon" General Hospital, University of Athens, Athens, Greece
| | - Dimitrios Mantas
- Second Department of Propaedeutic Surgery, Medical School, "Laikon" General Hospital, University of Athens, Athens, Greece
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15
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Harbi H, Fendri S, Sahnoun M, Amar MB, Mzali R. Fatal acute peritonitis due to perforated jejunal diverticulum. Presse Med 2016; 46:246-247. [PMID: 28040343 DOI: 10.1016/j.lpm.2016.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/23/2016] [Accepted: 11/21/2016] [Indexed: 12/01/2022] Open
Affiliation(s)
- Houssem Harbi
- Hôpital Habib Bourguiba, service de chirurgie générale, , Sfax, Tunisia.
| | - Sami Fendri
- Hôpital Habib Bourguiba, service de chirurgie générale, , Sfax, Tunisia
| | - Moez Sahnoun
- Hôpital Habib Bourguiba, service de chirurgie générale, , Sfax, Tunisia
| | - Mohamed Ben Amar
- Hôpital Habib Bourguiba, service de chirurgie générale, , Sfax, Tunisia
| | - Rafik Mzali
- Hôpital Habib Bourguiba, service de chirurgie générale, , Sfax, Tunisia
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16
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Horesh N, Klang E, Gravetz A, Nevo Y, Amiel I, Amitai MM, Rosin D, Gutman M, Zmora O. Jejunal Diverticulitis. J Laparoendosc Adv Surg Tech A 2016; 26:596-9. [DOI: 10.1089/lap.2016.0066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Nir Horesh
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Klang
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Radiology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Aviad Gravetz
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehonatan Nevo
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Imri Amiel
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Marianne Amitai
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Radiology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Zmora
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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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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18
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Hubbard TJE, Balasubramanian R, Smith JJ. Jejunal diverticulum enterolith causing perforation and upper abdominal peritonitis. BMJ Case Rep 2015; 2015:bcr-2015-210095. [PMID: 26174728 DOI: 10.1136/bcr-2015-210095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A patient presented with a 4 h history of acute onset, progressive upper abdominal pain. There was localised peritonitis, with raised inflammatory markers and lactate. CT scan showed a large calcified mass, with evidence of mesenteric twist/volvulus causing some degree of small bowel obstruction. At laparotomy, there were multiple jejunal diverticula, one of which had perforated due to a large enterolith. Resection of the affected jejunum and washout was performed and the patient recovered well. Complications of jejunal diverticula and enteroliths are reported and should be considered in patients with an acute abdomen.
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Affiliation(s)
| | | | - Jason J Smith
- Department of General Surgery, West Middlesex University Hospital, London, UK
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19
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De Minicis S, Antonini F, Belfiori V, Lo Cascio M, Marraccini B, Piergallini S, Mosca P, Macarri G. Small bowel diverticulitis with severe anemia and abdominal pain. World J Clin Cases 2015; 3:462-465. [PMID: 25984521 PMCID: PMC4419110 DOI: 10.12998/wjcc.v3.i5.462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 11/20/2014] [Accepted: 02/12/2015] [Indexed: 02/05/2023] Open
Abstract
The current case report is related to a male patient with diabetes, obesity [body mass index (BMI) 33], hypertension and recurrence of anemia associated to melena and deep asthenia. M.P., a 60-year-old obese individual, was referred to our department by the primary care unit (PCU) of our hospital for severe anemia (Hemoglobin 6.5 g/dL) associated to episodes of melena and abdominal pain. In the past 5 mo the patient referred to the local hospital 3 times for episodes of melena (hemoglobin levels showed anemia 9.8 g/dL) but the main gastroenterological exams were completely negative (colonoscopy and gastroscopy). The PCU of our Hospital, after stabilization of the main parameters and blood transfusion for the low levels of hemoglobin, referred the patient to gastroenterologists: the patient was subjected to both colonoscopy and gastroscopy that were negative. Due to the condition of acute severe hemorrhage the patient, during the first 3 h from the access to the PCU, was subjected to arteriography that did not reveal any hemorrhagic foci or vascular alterations. The video capsule for the study of the small bowel showed the presence of blood beginning from the third portion of duodenum but deep gastroscopy did not reveal it. The patient was then subjected to double balloon endoscopy that revealed a severe diverticulosis of the small bowel with blood from the diverticula. The entero-tomografia computerizzata confirmed the diagnosis and revealed an extension of the diverticula for almost the entire small bowel (no diverticula in the colon). The patient was subjected to wide spectrum antibiotic therapy with resolution of the symptoms and stabilization of hemoglobin levels. The surgeon suggests no indication to surgery for the wide area involved from the disease and potential high risk of complication due to the high BMI. At home, the patient started a monthly therapy with rifaximin and probiotics associated to mesalazine. At present, after 12 mo from the last episode of hemorrhage, the patient is in good clinical condition, reduced his body weight of about 7 kg and the hemoglobin levels appear in slow progressive increase (last measurement 13.2 g/dL).
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20
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Perforated jejunal diverticula secondary to a large faecolith: a rare cause of the acute abdomen. Case Rep Surg 2014; 2014:103943. [PMID: 25614847 PMCID: PMC4293786 DOI: 10.1155/2014/103943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/14/2014] [Accepted: 12/15/2014] [Indexed: 12/27/2022] Open
Abstract
Jejunal diverticula are uncommon and usually asymptomatic. Very rarely, they can lead to acute complications such as bleeding, obstruction, and perforation. This report describes our experience of a case of jejunal diverticula perforation secondary to a large faecolith, with particular focus on the aetiology and management of this rare condition.
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21
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Chaudhery B, Newman PA, Kelly MD. Small bowel obstruction and perforation secondary to primary enterolithiasis in a patient with jejunal diverticulosis. BMJ Case Rep 2014; 2014:bcr-2014-203833. [PMID: 24626387 DOI: 10.1136/bcr-2014-203833] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We describe a rare case of small bowel obstruction and perforation secondary to a primary enterolith in an 84-year-old female patient with jejunal diverticulosis. She underwent an emergency laparotomy, small bowel resection and primary anastomosis. Multiple jejunal diverticula and a large stone were identified at the time of operation. Analysis of the stone demonstrated mainly faecal material consistent with a true primary enterolith. A literature search of Medline and PubMed revealed three cases similar to the one described. The pathogenesis and management of enterolithiasis in jejunal diverticular disease is considered.
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Affiliation(s)
- Baber Chaudhery
- Department of General Surgery, North Bristol NHS Trust, Bristol, UK
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22
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Single-trocar transumbilical laparoscopy-assisted management of complicated jejunal diverticula. Surg Laparosc Endosc Percutan Tech 2013; 23:e78-80. [PMID: 23579535 DOI: 10.1097/sle.0b013e31826e4816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Small-intestinal nonmeckelian diverticula are very uncommon and are considered to be acquired pulsion diverticula. Most of these diverticula are asymptomatic and are simply incidental findings. Complicated-acquired diverticular disease of the jejunum and ileum is a diagnostic dilemma. Small-bowel diverticulum is diagnosed with the aid of radiography techniques, such as small-bowel contrast series or enteroclysis. Laparotomy remains the gold standard for a definite diagnosis of asymptomatic and complicated diverticula, but laparoscopy is also very useful in the diagnosis and treatment of this condition. A surgical approach is the best form of treatment for complicated jejunoileal diverticula. The current report is about a patient who presented with iron deficiency anemia caused by a complicated jejunal diverticulum and managed with single-trocar transumbilical laparoscopy.
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23
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Moris D, Vernadakis S. Jejunal diverticulosis as the obscure cause of acute abdominal pain. Surgery 2013; 155:1093-4. [PMID: 23452878 DOI: 10.1016/j.surg.2012.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 12/19/2012] [Indexed: 01/07/2023]
Affiliation(s)
- Demetrios Moris
- 1(st) Department of Surgery, Athens University School of Medicine, "Laikon" General Hospital, Athens, Greece.
| | - Spiridon Vernadakis
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Germany
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24
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Orlando G, Luppino IM, Gervasi R, Lerose MA, Amato B, Spagnuolo R, Marasco R, Doldo P, Puzziello A. Surgery for a gastric Dieulafoy's lesion reveals an occult bleeding jejunal diverticulum. A case report. BMC Surg 2012; 12 Suppl 1:S29. [PMID: 23173883 PMCID: PMC3499193 DOI: 10.1186/1471-2482-12-s1-s29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Jejunal diverticulosis is an uncommon disease and usually asymptomatic. It can be complicated not only by diverticulitis, but by hemorrhage, perforation, intussusception, volvulus, malabsorption and even small bowel obstruction due to enteroliths formed and expelled from these diverticula. Methods We describe a case of an occult bleeding jejunal diverticulum, casually discovered in a patient that was taken to surgery for a Dieulafoy’s lesion after unsuccessful endoscopic treatment. We performed a gastric resection together with an ileocecal resection. Macroscopic and microscopic examinations confirmed the gastric Dieulafoy’s lesion and demonstrated the presence of another source of occult bleeding in asymptomatic jejunal diverticulum. Discussion The current case emphasizes that some gastrointestinal bleeding lesions, although rare, can be multiple and result in potentially life-threatening bleeding. The clinician must be mindful to the possibility of multisite lesions and to the correlation between results of the investigations and clinical condition of the bleeding patient.
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Affiliation(s)
- G Orlando
- Gastroenterology and Endoscopy Unit, T Campanella Oncological Foundation, Catanzaro, Italy
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25
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Parikh S, Houlis N, Bordan D. Jejunal Diverticulitis: A Rare Cause of Abdominal Pain. Am Surg 2012. [DOI: 10.1177/000313481207800405] [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)
- Sahil Parikh
- St. Joseph's Regional Medical Center Paterson, New Jersey
| | | | - Dennis Bordan
- St. Joseph's Regional Medical Center Paterson, New Jersey
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26
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Schloericke E, Zimmermann MS, Hoffmann M, Kleemann M, Laubert T, Bruch HP, Hildebrand P. Complicated jejunal diverticulitis: a challenging diagnosis and difficult therapy. Saudi J Gastroenterol 2012; 18:122-8. [PMID: 22421718 PMCID: PMC3326973 DOI: 10.4103/1319-3767.93816] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND/AIM In contrast to diverticulosis of the colon, jejunal diverticulosis is a rare entity that often becomes clinically relevant only after exacerbations occur. The variety of symptoms and low incidence make this disease a difficult differential diagnosis. PATIENTS AND METHODS Data from all patients who were treated in our surgical department for complicated jejunal diverticulitis, that is, gastrointestinal hemorrhage or a diverticula perforation were collected prospectively over a 6-year period (January 2004 to January 2010) and analyzed retrospectively. RESULTS The median age among the 9 patients was 82 years (range: 54-87). Except for 2 cases (elective operation for a status postjejunal peridiverticulitis and a re-perforation of a diverticula in a patient s/p segment resection with free perforation), the diagnosis could only be confirmed with an exploratory laparotomy. Perforation was observed in 5 patients, one of which was a retroperitoneal perforation. The retroperitoneal perforation was associated with transanal hemorrhage. Hemodynamically relevant transanal hemorrhage requiring transfusion were the reason for an exploratory laparotomy in 2 further cases. In one patient, the hemorrhage was the result of a systemic vasculitis with resultant gastrointestinal involvement. A singular jejunal diverticulum caused an adhesive ileus in one patient. The extent of jejunal diverticulosis varied between a singular diverticulum to complete jejunal involvement. A tangential, transverse excision of the diverticulum was carried out in 3 patients. The indication for segment resection was made in the case of a perforation with associated peritonitis (n=4) as well as the presence of 5 or more diverticula (n=2). Histological analysis revealed chronic pandiverticulitis in all patients. Median operating time amounted to 142 minutes (range: 65-210) and the median in-hospital stay was 12 days (range: 5-45). Lethality was 0%. Major complications included secondary wound closure after s/p repeated lavage and bilateral pleural effusions in one case. Signs of malabsorption as the result of a short bowel syndrome were not observed. Minor complications included protracted intestinal atony in 2 cases and pneumonia in one case. Median follow-up was 6 months (range: 1-18). CONCLUSION Complicated jejunal diverticulitis often remains elusive preoperatively due to its unspecific clinical presentation. A definitive diagnosis can often only be made intraoperatively. The resection of all diverticula and/or the complete diverticula-laden segment is the goal in chronic cases. The operative approach chosen (tangential, transverse excision vs segment resection) should be based on the extent of the jejunal diverticulosis as well as the intraoperative findings.
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Affiliation(s)
- Erik Schloericke
- Department of Surgery, University of Schleswig Holstein, Campus Lübeck, Luebeck, Germany.
| | - Markus S. Zimmermann
- Department of Surgery, University of Schleswig Holstein, Campus Lübeck, Luebeck, Germany
| | - Martin Hoffmann
- Department of Surgery, University of Schleswig Holstein, Campus Lübeck, Luebeck, Germany
| | - Markus Kleemann
- Department of Surgery, University of Schleswig Holstein, Campus Lübeck, Luebeck, Germany
| | - Tilman Laubert
- Department of Surgery, University of Schleswig Holstein, Campus Lübeck, Luebeck, Germany
| | - Hans-Peter Bruch
- Department of Surgery, University of Schleswig Holstein, Campus Lübeck, Luebeck, Germany
| | - Phillip Hildebrand
- Department of Surgery, University of Schleswig Holstein, Campus Lübeck, Luebeck, Germany
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27
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Ter Horst M, Boer MCHD, Raber MH, Klaase JM. Giant Diverticulum of the Duodenum. Gastroenterology Res 2011; 4:289-293. [PMID: 27957031 PMCID: PMC5139869 DOI: 10.4021/gr359w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2011] [Indexed: 11/03/2022] Open
Abstract
A 50-year old female presented herself with abdominal bloating and pain in the Emergengy Department. The symptoms persisted and a clinical evaluation was made. A lesion suspect for a giant duodenal diverticulum was seen on the CT-scan, which was confirmed by enteroclysis. Surgical resection was performed. The diagnosis was histological confirmed after surgery. Small bowel diverticula are relatively common, with an estimated 5 - 22% incidence in the healthy population. They are usually asymptomatic, but can present with abdominal pain and weight loss. Complications such as bleeding and perforation can occur. Surgical resection is the treatment of choice in symptomatic patients.
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Affiliation(s)
- Matthijs Ter Horst
- Department of General Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | | | - Menno H Raber
- Department of General Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Joost M Klaase
- Department of General Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
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28
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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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29
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Nonose R, Valenciano JS, de Souza Lima JS, Nascimento EF, Silva CMG, Martinez CAR. Jejunal Diverticular Perforation due to Enterolith. Case Rep Gastroenterol 2011; 5:445-51. [PMID: 21960947 PMCID: PMC3180661 DOI: 10.1159/000330842] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Jejunal diverticulosis is a rare entity with variable clinical and anatomical presentations. Although there is no consensus on the management of asymptomatic jejunal diverticular disease, some complications are potentially life-threatening and require early surgical treatment. Small bowel perforation secondary to jejunal diverticulitis by enteroliths is rare. The aim of this study was to report a case of small intestinal perforation caused by a large jejunal enterolith. An 86-year-old woman was admitted with signs of diffuse peritonitis. After initial fluid recovery the patient underwent emergency laparotomy. The surgery showed that she had small bowel diverticular disease, mainly localized in the proximal jejunum. The peritonitis was due to intestinal perforation caused by an enterolith 12 cm in length, localized inside one of these diverticula. The intestinal segment containing the perforated diverticulum with the enterolith was removed and an end-to-end anastomosis was done to reconstruct the intestinal transit. The patient recovered well and was discharged from hospital on the 5th postoperative day. There were no signs of abdominal pain 1 year after the surgical procedure. Although jejunal diverticular disease with its complications, such as formation of enteroliths, is difficult to suspect in patients with peritonitis, it should be considered as a possible source of abdominal infection in the elderly patient when more common diagnoses have been excluded.
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Affiliation(s)
- Ronaldo Nonose
- Department of General Surgery, São Francisco University Hospital, Bragança Paulista, Brazil
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30
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Falidas E, Vlachos K, Mathioulakis S, Archontovasilis F, Villias C. Multiple giant diverticula of the jejunum causing intestinal obstruction: report of a case and review of the literature. World J Emerg Surg 2011; 6:8. [PMID: 21385440 PMCID: PMC3061903 DOI: 10.1186/1749-7922-6-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 03/08/2011] [Indexed: 01/12/2023] Open
Abstract
Multiple diverticulosis of jejunum represents an uncommon pathology of the small bowel. The disease is usually asymptomatic and must be taken into consideration in cases of unexplained malabsorption, anemia, chronic abdominal pain or discomfort. Related complications such as diverticulitis, perforation, bleeding or intestinal obstruction appear in 10-30% of the patients increasing morbidity and mortality rates. We herein report a case of a 55 year-old man presented at the emergency department with acute abdominal pain, vomiting and fever. Preoperative radiological examination followed by laparotomy revealed multiple giant jejunal diverticula causing intestinal obstruction. We also review the literature for this uncommon disease.
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Affiliation(s)
- Evangelos Falidas
- First Department of General Surgery, 417 NIMTS, Veterans Hospital of Athens, 10-12 Monis Petraki, 11521, Athens, Greece
| | - Konstantinos Vlachos
- First Department of General Surgery, 417 NIMTS, Veterans Hospital of Athens, 10-12 Monis Petraki, 11521, Athens, Greece
| | - Stavros Mathioulakis
- First Department of General Surgery, 417 NIMTS, Veterans Hospital of Athens, 10-12 Monis Petraki, 11521, Athens, Greece
| | - Fotis Archontovasilis
- First Department of Therapeutic Endoscopy and Laparoscopic Surgery, Iaso General Hospital, 264 Mesogion Avenue, 15562, Cholargos, Greece
| | - Constantinos Villias
- First Department of General Surgery, 417 NIMTS, Veterans Hospital of Athens, 10-12 Monis Petraki, 11521, Athens, Greece
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