Jejunal diverticular disease: a report of three cases

[Jejunal diverticular disease: a rare cause of gastrointestinal bleeding]

Background

Digestive bleeding is an important cause of hospital admission; however, the mortality rate in these patients has not been reduced. Digestive bleeding has a multiple etiology; specifically, bleeding from the small intestine accounts for 5 to 10% of gastrointestinal hemorrhages, of which between 0.06% and 5% of cases are caused by diverticula of the small intestine. Most cases are asymptomatic; however, the symptomatic form is highly variable and can present with multiple complications, such as massive bleeding. Therefore, the objective of this study was to explore the approach to jejunal diverticular disease (JDD) with gastrointestinal bleeding.

Clinical case

A 48-year-old male patient presented with massive digestive bleeding of unknown origin, initially treated with angiography and embolization, with a satisfactory outcome. However, six days after discharge, the patient experienced new massive bleeding that required an urgent exploratory laparotomy, during which jejunal diverticular disease (JDD) of the small intestine was identified.

Conclusions

Diverticula of the small intestine are usually asymptomatic, and complications are rare; however, they can affect the patient's survival. Therefore, an appropriate approach, accurate and timely diagnosis, and a multidisciplinary management strategy are required to offer the best therapeutic options for the patient.

Jejunal diverticulosis presenting as intestinal obstruction-A case report of a rare association

Jejunal diverticula are rare medical conditions with an incidence of 0.3%-2.5%, mostly discovered perioperatively. Our patient, 60 years old female, presented in an emergency with complaints of constipation, vomiting, abdominal pain, and distension. On examination, her abdomen was markedly distended with generalized tenderness. An erect abdominal X-ray revealed multiple air-fluid levels, which suggests small bowel obstruction. A diagnosis of jejunal diverticula was made on exploratory laparotomy. No evidence of granuloma or malignancy was seen on histopathological examination. Segmental resection of the affected jejunum was carried out, followed by end-to-end primary anastomosis. The patient was discharged on postoperative Day 6 with complete recovery at 2 weeks follow-up visit.

Perforated jejunal diverticulum as an unsual cause of acute abdomen: A case report

INTRODUCTION AND IMPORTANCE

Jejunal divertica is a rare entity with an often clinically silent course. However, it may be associated to life-threatening complications such as perforation. Therefore it should be considered in every case of acute abdomen.

CASE PRESENTATION

A 60-year-old female presented with a generalized abdominal pain associated with vomiting evolving for 24 h. Physical examination found an irreducible and tender hernia in the umbilical region with abdominal guarding. Laboratory test results showed a biological inflammatory syndrome. The primary diagnosis of strangulated umbilical hernia was suspected and the patient underwent an emergency laparotomy. Intra-operative examination revealed mutiple jejunal diverticula, with a perforation in one diverticulum leading to generalized peritonitis. A bowel resection and peritoneal lavage were performed with good outcome.

CLINICAL DISCUSSION

Jejunal diverticula is a challenging condition with various non-specific clinical presentations. Jejunal perforation is its most feared complication. Deceitful abdominal examination among elderly patients and lack of specific signs may lead to diagnostic delay responsible for high mortality rate and poor prognosis. Adjunctive imaging modalities may be needed to help establish a prompt diagnosis and dictate management strategy. Treatment of perforated jejunal diverticulum is based on limited bowel resection associated to primary anastomosis.

CONCLUSION

Jejunal diverticulitis should be kept in mind as a differential diagnosis in every case of acute abdomen. High index of clinical suspicion and eventual further radiological examinations are required to avoid misdaignosis and save patients' lives.