1
|
Kwon LM, Lee K, Kim MJ, Lee IJ, Kim GC. Acute Ileal Diverticulitis: Computed Tomography and Ultrasound Findings. Diagnostics (Basel) 2023; 13:diagnostics13081408. [PMID: 37189509 DOI: 10.3390/diagnostics13081408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Acute ileal diverticulitis is a rare disease mimicking acute appendicitis. Inaccurate diagnosis with a low prevalence and nonspecific symptoms leads to delayed or improper management. METHODS This retrospective study aimed to investigate the characteristic sonographic (US) and computed tomography (CT) findings with clinical features in seventeen patients with acute ileal diverticulitis diagnosed between March 2002 and August 2017. RESULTS The most common symptom was abdominal pain (82.3%, 14/17) localized to the right lower quadrant (RLQ) in 14 patients. The characteristic CT findings of acute ileal diverticulitis were ileal wall thickening (100%, 17/17), identification of inflamed diverticulum at the mesenteric side (94.1%, 16/17), and surrounding mesenteric fat infiltration (100%, 17/17). The typical US findings were outpouching diverticular sac connecting to the ileum (100%, 17/17), peridiverticular inflamed fat (100%, 17/17), ileal wall thickening with preserved layering pattern (94.1%, 16/17), and increased color flow to the diverticulum and surrounding inflamed fat on color Doppler imaging (100%, 17/17). The perforation group had a significantly longer hospital stay than non-perforation group (p = 0.002). In conclusion, acute ileal diverticulitis has characteristic CT and US findings that allow radiologists to accurately diagnose the disease.
Collapse
Affiliation(s)
- Lyo Min Kwon
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Kwanseop Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Min-Jeong Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - In Jae Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Gab Chul Kim
- Department of Radiology, Kyungpook National University Medical Center, Daegu 41404, Republic of Korea
| |
Collapse
|
2
|
Acute Ileo-jejunal Diverticulitis: a 10-Year Single-center Experience. Indian J Surg 2022. [DOI: 10.1007/s12262-021-02893-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
3
|
Barr R, Freeman C, Culhane J. Eosinophilic Gastroenteritis Causing Small Bowel Diverticulosis and Volvulus: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933180. [PMID: 34608111 PMCID: PMC8503799 DOI: 10.12659/ajcr.933180] [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: 11/17/2022]
Abstract
Patient: Female, 83-year-old
Final Diagnosis: Eosinophilic gastroentritis • jejunal diverticulosis
Symptoms: Abdominal pain • obstruction
Medication: —
Clinical Procedure: —
Specialty: Surgery
Collapse
Affiliation(s)
- Rebecca Barr
- Department of General Surgery, Saint Louis University, St Louis, MO, USA
| | - Carl Freeman
- Department of General Surgery, Saint Louis University, St Louis, MO, USA
| | - John Culhane
- Department of General Surgery, Saint Louis University, St Louis, MO, USA
| |
Collapse
|
4
|
Luitel P, Shrestha BM, Adhikari S, Kandel BP, Lakhey PJ. Incidental finding of jejunal diverticula during laparotomy for suspected adhesive small bowel obstruction: A case report. Int J Surg Case Rep 2021; 85:106268. [PMID: 34388902 PMCID: PMC8355921 DOI: 10.1016/j.ijscr.2021.106268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/31/2021] [Accepted: 08/01/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Jejunal diverticula are usually asymptomatic and are discovered incidentally. While rare, their complications may be life-threatening. They should be considered as differential diagnoses in undiagnosed complaints of chronic abdominal pain, malabsorption, anemia, gastrointestinal bleed and intestinal obstruction. CASE PRESENTATION A 66-year lady, known hypertensive and hypothyroidism with history of hysterectomy presented with symptoms suggestive of small bowel obstruction. Intraoperatively adhesions between loops of the small intestine, multiple diverticula with two of them impending perforation were found. Resection of 10 cm of jejunum containing diverticula with end-to-end anastomosis was performed. She had uneventful recovery and on 2 months of follow-up she was doing well. CLINICAL DISCUSSION Although diverticula can be found anywhere along the gastrointestinal tract, jejunal diverticula are rare. Most patients are asymptomatic, symptoms if present is non-specific that delay diagnosis causing patients to land up with complications. They are diagnosed incidentally on endoscopy or imaging rather than through clinical suspicion. Asymptomatic cases do not mandate treatment while symptomatic cases can be managed conservatively with surgery being reserved for those with complications. CONCLUSION Small bowel obstruction due to jejunal diverticula is a rare entity, a diagnosis of which can be confirmed only intra-operatively. So it must be borne as a differential in small bowel obstruction. Timely diagnosis and management will prevent life-threatening complications of it.
Collapse
Affiliation(s)
- Prajjwol Luitel
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal.
| | | | - Shankar Adhikari
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Bishnu Prasad Kandel
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Paleswan Joshi Lakhey
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| |
Collapse
|
5
|
Watanabe Y, Murata M, Hirota M, Suzuki R. Whole jejunoileal diverticulosis with recurrent inflammation and perforation: A case report. Int J Surg Case Rep 2021; 84:106020. [PMID: 34119945 PMCID: PMC8196046 DOI: 10.1016/j.ijscr.2021.106020] [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: 04/10/2021] [Revised: 05/22/2021] [Accepted: 05/22/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Jejunoileal diverticulitis is uncommon and poorly understood. We report a case of whole jejunoileal diverticulosis with recurrent inflammation and perforation. Case presentation A 72-year-old man with hemodialysis presented with fever and abdominal pain. The patient had a medical history of twice having jejunoileal diverticulitis. Serum testing indicated a white blood cell count of 15,670/μL and a C-reactive protein level of 10.31 mg/dL. Contrast-enhanced computed tomography showed jejunoileal diverticulosis with the concomitant mesenteric fat opacity and a 60-mm × 45-mm mass lesion containing extraluminal air bubbles. Jejunoileal partial resection was performed. Multiple diverticulosis was recognized over the entire jejunoileum, and the pouches existed along entry points of the bowel vascular supply through the mesentery. Intestinal resection was limited to the intestinal loop associated with complicated diverticulitis with abscess. Macroscopic examination revealed multiple jejunoileal diverticulosis. In the reddened mucosa, the diverticulitis and mesenteric perforation were recognized. Microscopic examination showed protrusion of mucosal and submucosal layers through a defect in the muscular layer with gangrenous inflammation. These findings supported a diagnosis of jejunoileal diverticulitis with perforation and abscess. The patient had no postoperative complications and no recurrence within 6 months. Discussion Treatment for jejunoileal diverticulitis should be individualized for each patient according to their degree of inflammation, recurrence, and the patient's background. Conclusion Extensive diverticulosis over the entire jejunoileum is very rare. In this case, the section of the inflamed diverticulosis can be distinguished and resected to avoid a short-bowel syndrome, which should lead to an uneventful postoperative course. Jejunoileal diverticulitis is uncommon in clinical practice and poorly understood. Multiple diverticula were recognized over the entire jejunoileum in our case. Treatment for jejunoileal diverticulitis should be individualized for each patient. The section involving only the inflamed diverticulosis should be resected to avoid a short-bowel.
Collapse
Affiliation(s)
- Yoshifumi Watanabe
- Department of Surgery, Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka, Japan.
| | - Masaru Murata
- Department of Surgery, Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka, Japan.
| | - Masashi Hirota
- Department of Surgery, Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka, Japan.
| | - Rei Suzuki
- Department of Surgery, Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka, Japan.
| |
Collapse
|
6
|
Giuffrida M, Perrone G, Di Saverio S, Annicchiarico A, Pattonieri V, Bonati E, Tarasconi A, Catena F. Jejunal diverticulitis: Things to know to prevent diagnostic mistake. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021154. [PMID: 33944837 PMCID: PMC8142753 DOI: 10.23750/abm.v92is1.9679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 11/14/2020] [Indexed: 12/25/2022]
Abstract
The jejunal diverticula are relatively rare. A female patient was admitted at our emergency department with acute abdominal pain and vomiting. CT-scan of the abdomen showed multiple diverticula in the colon and multiple intra-abdominal fluid collections, also in the left quadrants of the abdomen. Free intraperitoneal extraluminal air was also observed, suggesting bowel perforation. Surgical exploration showed multiple diverticula of the jejunum with a perforated jejunal diverticulum extending approximately 10 cm from ligament of Treitz. Jejunal resection was performed. Jejunal diverticulitis is rare, but it can lead to an acute abdomen increasing mortality especially in elderly patients. Jejunal diverticulitis usually starts with features that mimic colonic diverticulitis. In patients with personal history of colonic diverticulosis and suspected diverticulitis, jejunal or ileal diverticulitis must be excluded occurring with a frequency of 2.3% in patients with known diverticulosis. In absence of pathognomonic colonic diverticulitis CT findings, small intestine acute complicated diverticulitis should be always suspected. In complicated jejunal diverticulitis surgical treatment is mandatory and a laparotomy can be needed for a better management. (www.actabiomedica.it)
Collapse
Affiliation(s)
| | | | | | | | | | - Elena Bonati
- General Surgery Unit, Parma University Hospital.
| | | | | |
Collapse
|
7
|
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: 0] [Impact Index Per Article: 0] [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.
Collapse
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
| |
Collapse
|
8
|
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
| |
Collapse
|
9
|
Sotirova I, Gklavas A, Papalouka D, Gourtsoyianni S, Christodoulou D, Papaconstantinou I. Multiple Small Bowel Diverticula Were an Unexpected Finding During Laparoscopic Enterectomy for Crohn's Disease. Med Arch 2020; 74:142-145. [PMID: 32577058 PMCID: PMC7296412 DOI: 10.5455/medarh.2020.74.142-145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Small bowel diverticulosis (SBD) is a rare entity. Although it is usually an asymptomatic condition, clinical manifestations may vary from non-specific clinical signs to severe and complicated disease. The coexistence of SBD and Crohn’s disease (CD) is rarely reported in the current literature. Aim: We present a rare case of concomitant Crohn’s disease (CD) and SBD in a male patient, where multiple jejunal diverticula were an incidental intraoperative finding. Preoperative evaluation with magnetic resonance enterography (MRE) failed to recognize the coexistence of these two entities. Surgeons should be aware of the possibility of this rare situation. Case report: A 52-year-old Caucasian male diagnosed with CD was referred to our department for surgical intervention due to an ileal stricture. The patient reported no past medical history, except for a few episodes of bloody diarrhoea during a three-year period. The index colonoscopy revealed luminal narrowing in the ileum at approximately 70 cm proximal to the ileocaecal valve, and biopsies revealed findings compatible with CD. Clinical examination and laboratory tests were unremarkable one day before surgery. The patient underwent laparoscopic segmental resection of the affected part of the ileum. Intraoperatively, multiple non-inflamed diverticula along the jejunum extending from the Treitz ligament to the proximal ileum were recognized. Our patient had an uncomplicated post-operative course and was discharged on the fifth post-operative day. Pathological examination revealed features compatible with CD in the active phase. The patient was referred to his gastroenterological team for further consultation regarding the appropriate post-operative management. Conclusion: Concomitant CD and SBD is a rare condition, and the differential diagnosis may be challenging due to overlapping symptoms.
Collapse
Affiliation(s)
- Ira Sotirova
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Antonios Gklavas
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Dimitra Papalouka
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Sofia Gourtsoyianni
- First Department of Radiology, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Dimitrios Christodoulou
- Department of Gastroenterology and Hepatology, University Hospital of Ioannina and Medical School of Ioannina, Ioannina 45110, Greece
| | - Ioannis Papaconstantinou
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens 11528, Greece
| |
Collapse
|
10
|
Gurala D, Idiculla PS, Patibandla P, Philipose J, Krzyzak M, Mukherjee I. Perforated Jejunal Diverticulitis. Case Rep Gastroenterol 2020; 13:521-525. [PMID: 31911765 DOI: 10.1159/000503896] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/03/2019] [Indexed: 11/19/2022] Open
Abstract
Small intestinal diverticula are very rare; their incidence ranges from 0.06 to 1.3%, with a higher prevalence after the 6th decade of life. Among these small intestinal diverticula, duodenal diverticula are more frequent, followed by diverticula of the jejunum and ileum. A jejunal diverticulum is usually asymptomatic; sometimes patients complain of vague chronic symptoms like malabsorption, pain, or nausea that easily lead to misdiagnosis. Complications are rarely reported, only in 10% of patients. We report a unique case of a 70-year-old female who presented with confusion due to sepsis from perforated jejunal diverticulitis, which was successfully managed with initial resuscitation and definitive surgery.
Collapse
Affiliation(s)
- Dhineshreddy Gurala
- Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA
| | - Pretty Sara Idiculla
- Medicine, Sree Gokulam Medical College and Research Foundation, Trivandrum, India
| | - Prateek Patibandla
- Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA
| | - Jobin Philipose
- Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA
| | - Michael Krzyzak
- Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA
| | - Indraneil Mukherjee
- Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
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]
|
13
|
A Rare Presentation of Small Bowel Diverticulosis Causing Chronic Obstruction and Malnutrition: A Case Study with Review of Literature. Case Rep Surg 2019; 2019:2548631. [PMID: 30755807 PMCID: PMC6348891 DOI: 10.1155/2019/2548631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/04/2018] [Accepted: 12/26/2018] [Indexed: 02/07/2023] Open
Abstract
Small bowel diverticulosis is an uncommon entity. Clinical presentation of small intestinal diverticulosis is variable. A high mortality is associated with complications such as chronic malnutrition, haemorrhage, intestinal obstruction, and perforation. We report a case of a 63-year-old female with multiple small bowel diverticuli spanning from the first part of the duodenum to the proximal ileum presenting with chronic malnutrition and subacute intestinal obstruction. Although exploratory laparotomy was performed, we opted for a totally conservative treatment in order to avoid complications such as short gut syndrome and anastomotic leakage.
Collapse
|
14
|
Abstract
This article describes the epidemiology, pathogenesis, diagnosis, and treatment of three rare variants of diverticular disease: cecal and right-sided colonic diverticula, giant colonic diverticula, and small bowel diverticula.
Collapse
Affiliation(s)
- Sanjay Mohanty
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Shawn P Webb
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan
| |
Collapse
|
15
|
Acute Jejunoileal Diverticulitis: Multicenter Descriptive Study of 33 Patients. AJR Am J Roentgenol 2018; 210:1245-1251. [DOI: 10.2214/ajr.17.18777] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
16
|
|
17
|
Imaging of Small Bowel. Emerg Radiol 2018. [DOI: 10.1007/978-3-319-65397-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
18
|
Small bowel diverticulitis: an imaging review of an uncommon entity. Emerg Radiol 2016; 24:195-205. [PMID: 27815648 DOI: 10.1007/s10140-016-1448-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 09/29/2016] [Indexed: 02/07/2023]
Abstract
In this review, we discuss the clinical and radiologic findings of small bowel diverticulosis, which is infrequently encountered during practice and far less common than colonic diverticulosis. Small bowel diverticulosis can present with a range of emergent symptomatic complications including diverticulitis, perforation, or hemorrhage. Here, we focus on the clinical features, pathogenesis, radiologic findings, and treatment of small bowel diverticulitis. Although not routinely considered in the differential diagnosis of an acute abdomen, prospective radiologic diagnosis of small bowel diverticulitis is important and can lead to conservative treatment thus preventing unnecessary exploratory laparotomy.
Collapse
|
19
|
Small intestinal amyloidosis: a rare cause of diverticular disease. Case Rep Pathol 2014; 2014:362835. [PMID: 25002983 PMCID: PMC4068059 DOI: 10.1155/2014/362835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 05/29/2014] [Indexed: 12/22/2022] Open
Abstract
Systemic amyloidosis frequently involves the small intestine. However, its association with diverticular disease has been seldom reported to date. To draw attention to this rare but potentially harmful association, we herein present an additional case of small bowel diverticular disease associated with amyloidosis.
Collapse
|
20
|
Abstract
The small intestine is an uncommon site of gastro-intestinal (GI) bleeding; however it is the commonest cause of obscure GI bleeding. It may require multiple blood transfusions, diagnostic procedures and repeated hospitalizations. Angiodysplasia is the commonest cause of obscure GI bleeding, particularly in the elderly. Inflammatory lesions and tumours are the usual causes of small intestinal bleeding in younger patients. Capsule endoscopy and deep enteroscopy have improved our ability to investigate small bowel bleeds. Deep enteroscopy has also an added advantage of therapeutic potential. Computed tomography is helpful in identifying extra-intestinal lesions. In cases of difficult diagnosis, surgery and intra-operative enteroscopy can help with diagnosis and management. The treatment is dependent upon the aetiology of the bleed. An overt bleed requires aggressive resuscitation and immediate localisation of the lesion for institution of appropriate therapy. Small bowel bleeding can be managed by conservative, radiological, pharmacological, endoscopic and surgical methods, depending upon indications, expertise and availability. Some patients, especially those with multiple vascular lesions, can re-bleed even after appropriate treatment and pose difficult challenge to the treating physician.
Collapse
Affiliation(s)
- Deepak Gunjan
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
21
|
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.
Collapse
Affiliation(s)
- Baber Chaudhery
- Department of General Surgery, North Bristol NHS Trust, Bristol, UK
| | | | | |
Collapse
|
22
|
Severe iron deficiency: rare etiology, easy treatment. Dig Dis Sci 2014; 59:538-42. [PMID: 24077943 DOI: 10.1007/s10620-013-2880-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 09/05/2013] [Indexed: 12/09/2022]
|
23
|
Affiliation(s)
| | | | - Rayyan Pervez
- Rayyan Pervez, Department of Radiology,, Shifa International Hospitals Ltd,, Flat 307 Sugra Tower F-11/1,, Islamabad, Punjab 44000, Pakistan, T: 92-333-515-7698,
| |
Collapse
|
24
|
Congenital diverticular disease of the entire colon. Case Rep Surg 2013; 2013:319026. [PMID: 23662238 PMCID: PMC3639703 DOI: 10.1155/2013/319026] [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] [Received: 01/21/2013] [Accepted: 03/18/2013] [Indexed: 11/17/2022] Open
Abstract
Congenital or true colonic diverticulosis is a rare condition typified by the preservation of the colonic wall architecture within the diverticular outpouching. Cases of multiple jejunal diverticula have been reported as well as cases of solitary giant diverticula of the colon. There have been no reports in the literature of pancolonic congenital diverticulosis.
Collapse
|
25
|
Singh A, Desser TS, Ferucci J. Imaging of Small Bowel. Emerg Radiol 2013. [DOI: 10.1007/978-1-4419-9592-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
26
|
Hu JL, Chen WZ. Midgut volvulus due to jejunal diverticula: A case report. World J Gastroenterol 2012; 18:5826-9. [PMID: 23155328 PMCID: PMC3484356 DOI: 10.3748/wjg.v18.i40.5826] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 09/10/2012] [Accepted: 09/19/2012] [Indexed: 02/06/2023] Open
Abstract
Jejunal diverticulosis is uncommon and often asymptomatic. It can produce significant complications, and some complications are potentially life threatening and require early surgical treatment, such as obstruction, hemorrhage and perforation. There is no consensus on the management of this disease. Only a few cases of jejunal diverticulosis with midgut volvulus have been reported. We herein report a case of 57-year-old woman with jejunal diverticulosis causing small bowel volvulus who complained of intermittent upper abdominal pin-prick for 5 years that eventually progressed to a complete obstruction. The computed tomography scans revealed a mesenteric vessel "whirlpool" and laparotomy showed midgut volvulus secondary to jejunal diverticula. This case highlights jejunal diverticulosis causing small bowel volvulus as an uncommon mechanism of small bowel obstruction, which should be included in the differential diagnosis of small bowel obstruction.
Collapse
|
27
|
Iwamuro M, Hanada M, Kominami Y, Higashi R, Mizuno M, Yamamoto K. Endoscopic hemostasis for hemorrhage from an ileal diverticulum. World J Gastrointest Endosc 2011; 3:154-6. [PMID: 21860685 PMCID: PMC3159504 DOI: 10.4253/wjge.v3.i7.154] [Citation(s) in RCA: 3] [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: 02/02/2011] [Revised: 04/26/2011] [Accepted: 05/15/2011] [Indexed: 02/05/2023] Open
Abstract
Hemorrhage from a non-Meckelian jejunoileal diverticulum is rare, and it is generally difficult to diagnose the source of the bleeding. Here, we report the case of a 59-year-old male with hemorrhage from an ileal diverticulum. Contrast computed tomography scans demonstrated the ileal diverticulum and extravasation of the contrast medium around it. The diagnosis was then made by computed tomography scans, and endoscopic mechanical hemostasis was performed under colonoscopy with three metal clips. The management of hemorrhage from jejunoileal diverticula is discussed.
Collapse
Affiliation(s)
- Masaya Iwamuro
- Masaya Iwamuro, Department of Internal Medicine, Hiroshima City Hospital, Hiroshima 730-8518, Japan
| | | | | | | | | | | |
Collapse
|
28
|
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: 21] [Impact Index Per Article: 1.6] [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.
Collapse
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
| |
Collapse
|
29
|
Chen TH, Chiu CT, Lin WP, Su MY, Hsu CM, Chen PC. Application of double-balloon enteroscopy in jejunal diverticular bleeding. World J Gastroenterol 2010; 16:5616-20. [PMID: 21105196 PMCID: PMC2992681 DOI: 10.3748/wjg.v16.i44.5616] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy of endoscopic diagnosis and therapy for jejunal diverticular bleeding.
METHODS: From January 2004 to September 2009, 154 patients underwent double-balloon enteroscopy (DBE) for obscure gastrointestinal bleeding. Ten consecutive patients with jejunal diverticula (5 males and 5 females) at the age of 68.7 ± 2.1 years (range 19-95 years) at Chang Gung Memorial Hospital, Academic Tertiary Referral Center, were enrolled in this study.
RESULTS: Of the 10 patients, 5 had melena, 2 had hematochezia, 2 had both melena and hematochezia, 1 had anemia and dizziness. DBE revealed ulcers with stigmata of recent hemorrhage in 6 patients treated by injection of epinephrine diluted at 1:10 000, Dieulafoy-like lesions in 4 patients treated by deploying hemoclips on the vessels, colonic diverticula in 2 patients, and duodenal diverticula in 3 patients, respectively. Of the 2 patients who underwent surgical intervention, 1 had a large diverticulum and was referred by the surgeon for DBE, 1 received endoscopic therapy but failed due to massive bleeding. One patient had a second DBE for recurrent hemorrhage 7 mo later, which was successfully treated with a repeat endoscopy. The mean follow-up time of patients was 14.7 ± 7.8 mo.
CONCLUSION: DBE is a safe and effective treatment modality for jejunal diverticular bleeding.
Collapse
|
30
|
Abstract
A 25-year-old African American female with no prior medical/surgical history presented with abdominal pain and fever. A computed tomography scan of the abdomen and pelvis showed jejunal wall thickening with an air-fluid-filled mass in the adjacent mesentery. At laparotomy, a segmental jejunal resection with the abscess cavity followed by primary anastomosis was performed. Pathological evaluation of the specimen revealed a large mesenteric abscess contiguous with a perforated solitary jejunal diverticulum. We provide a discussion of jejunal diverticulitis as an unusual cause of peritonitis.
Collapse
|
31
|
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
| |
Collapse
|
32
|
Elderly patient with acute, left lower abdominal pain: perforated jejunal diverticulitis (2010:7b). Eur Radiol 2010; 20:2541-5. [PMID: 20845020 DOI: 10.1007/s00330-010-1726-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 12/09/2009] [Indexed: 12/14/2022]
Abstract
An elderly patient with acute, left, lower abdominal pain is described, for whom the diagnosis of perforated jejunal diverticulitis was established by computed tomography (CT). The presence of a jejunal segmental inflammatory process, with or without abscess or perforation, in the setting of jejunal diverticulosis, is very suggestive of jejunal diverticulitis.
Collapse
|
33
|
Lacz NL, Zurlo JV. Small bowel diverticulitis: an often overlooked cause of acute abdomen. Emerg Radiol 2010; 17:497-501. [PMID: 20697923 DOI: 10.1007/s10140-010-0896-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 07/23/2010] [Indexed: 12/16/2022]
Abstract
We present 3 cases of small bowel diverticulitis ultimately presenting to our Emergency Department over a span of 2 years. Though the final diagnosis was the same, each patient's symptomatology was different, mimicking more common pathologies. Thus, it is important to consider this entity when confronted with signs and symptoms of acute abdomen, especially in the elderly. A missed or delayed diagnosis can lead to costly erroneous studies, incorrect treatments and delay in proper management, resulting in significant morbidity and even mortality. The variety of presentations can often be misleading; therefore, a high index of suspicion is needed on the part of the Emergency Department physician and Radiologist.
Collapse
Affiliation(s)
- Nicole L Lacz
- Department of Radiology, St. Barnabas Medical Center, Livingston, NJ, USA.
| | | |
Collapse
|
34
|
Aganovic L, Lee YK, Chu PK, Cassidy FH. Recurrent non-surgical pneumoperitoneum due to jejunal diverticulosis. J Emerg Med 2010; 43:e175-9. [PMID: 20456904 DOI: 10.1016/j.jemermed.2010.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 11/12/2009] [Accepted: 01/05/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND The presence of free intraperitoneal gas usually warrants emergent surgery. In rare instances, however, non-surgical conditions such as jejunal diverticulosis can cause pneumoperitoneum and do not require intervention. OBJECTIVES The objective of this article is to provide the computed tomography (CT) scan findings of jejunal diverticulosis causing pneumoperitoneum. The article will also discuss other non-surgical causes of spontaneous pneumoperitoneum to increase awareness and avoid unnecessary surgery. CASE REPORT We describe a case of recurrent pneumoperitoneum due to jejunal diverticulosis in which the patient remained asymptomatic and free of complications with repeated evaluations in the emergency department over the course of 18 months. CONCLUSION Although spontaneous pneumoperitoneum due to jejunal diverticulosis is a rare finding, when it does occur, this condition must be distinguished from other forms of pneumoperitoneum to avoid unnecessary surgery. CT scan findings of multiple rounded, variably sized jejunal outpouchings filled with oral contrast are helpful in diagnosing jejunal diverticulosis and confirming the decision for conservative management of the patient.
Collapse
Affiliation(s)
- Lejla Aganovic
- Department of Radiology, University of California Medical Center, San Diego, California, USA
| | | | | | | |
Collapse
|
35
|
Chugay P, Choi J, Dong XD. Jejunal diverticular disease complicated by enteroliths: Report of two different presentations. World J Gastrointest Surg 2010; 2:26-9. [PMID: 21160831 PMCID: PMC2999198 DOI: 10.4240/wjgs.v2.i1.26] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 10/24/2009] [Accepted: 10/31/2009] [Indexed: 02/06/2023] Open
Abstract
Jejunal diverticula are quite rare. Furthermore, small bowel diverticular disease resulting in enteroliths can lead to complications necessitating surgical intervention. In this manuscript, we report two presentations of jejunal diverticulum with complications from enteroliths followed by a review of the literature. The first case was that of a 79-year-old male who presented with abdominal pain and was found, on computed tomography (CT) scan, to have evidence of intestinal perforation. A laparotomy showed that he had perforated jejunal diverticulitis. The second case was that of an 89-year-old female who presented with recurrent episodes of bowel obstruction. A laparotomy showed that she had an enterolith impacted in her jejunum in the presence of significant diverticular disease. Although a rare entity, familiarity with jejunal diverticular disease, its complications, and its management, should be part of every surgeon’s base of knowledge when considering abdominal pathology.
Collapse
Affiliation(s)
- Paul Chugay
- Paul Chugay, John Choi, Xiang Da Dong, Department of Surgery, Stamford Hospital - Affiliate of Columbia University, 30 Shelburne Road, Stamford, CT 06904, United States
| | | | | |
Collapse
|
36
|
Abstract
Nonmeckelian jejunoileal diverticula (JID) are rare, but potentially clinically significant lesions. Despite recent advances in modern diagnostic modalities, diagnosis of JID may be problematic. Upper gastrointestinal contrast series with small bowel follow-through examination and mainly enteroclysis are the 2 main diagnostic methods. In selected cases (mainly complicated JID), the physician could use other diagnostic methods, such as ultrasound, computed tomography, endoscopy, intraoperative endoscopy, laparoscopy, radiotagged erythrocyte bleeding scans, and selective mesenteric arteriography. JID may be clinically silent or symptomatic causing chronic pain or malabsorption or other acute complications, such as hemorrhage, inflammation, perforation, etc. Laparotomy remains the gold standard for definite diagnosis of asymptomatic and complicated diverticula. Treatment should be individualized. Surgery could be indicated, mainly in symptomatic diverticula. The extent of resection may be a problem, especially in patients with extensive disease involving large parts of the bowel. In these cases, clinical judgment is required from the part of surgeon to avoid short bowel syndrome.
Collapse
|
37
|
Jejunal disorders: potentially lethal causes of acute abdomen are still overlooked. Surg Laparosc Endosc Percutan Tech 2009; 19:39-42. [PMID: 19238065 DOI: 10.1097/sle.0b013e3181964758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To highlight the importance of considering jejunal disorders in the differential diagnosis of acute abdomen. Although these conditions are relatively uncommon, we should keep in mind that jejunum still occurs, and deserves consideration. METHOD This study was carried out at King Abdullah University Hospital, Jordan. Medical records of 7 patients with uncommon jejunal disorders that were encountered between 2001 and 2007 were retrospectively evaluated. We had 1 patient with jejunal diverticulitis, 1 with jejunal intussusception, 2 with jejuno-ileal tuberculosis complicated by intestinal obstruction, and 3 with acute mesenteric ischemia. All of these patients presented with acute abdominal pain of nonspecific features. Radiologic workup, along with surgical intervention, was necessary to reach a final diagnosis. RESULTS Only 1 patient matched preoperative diagnosis, in which computed tomography scan revealed the presence of intussusception. The remaining patients were diagnosed intraoperatively. Laparoscopy and/or laparotomy with resection were performed. Morbidity was within acceptable range. There was no mortality. CONCLUSIONS Jejunal disorders are potentially serious, and are underestimated. They are considered important causes of acute abdomen. Although they should not be at the top of a differential diagnostic list, they should always be ruled out when there is no apparent cause.
Collapse
|
38
|
Abstract
This article presents the differential diagnosis for small bowel ischemia. Clinical presentation of small bowel ischemia is variable, presenting with a myriad of specific or nonspecific clinical and laboratory findings. The imaging findings associated with small bowel ischemia are variable and combinations of findings may be necessary for definitive diagnosis. More specific imaging findings in patients with acute small intestine ischemia include bowel wall gas, mesenteric vessel occlusion, mesenteric venous gas, portal venous gas, or absence of bowel wall enhancement. Less specific imaging findings include small bowel wall thickening, mesenteric stranding, and mesenteric fluid. Further complicating the issue, several small intestinal disease processes may mimic ischemia both clinically and radiographically. These alternate diagnoses include infectious, inflammatory, and infiltrative processes.
Collapse
|
39
|
|
40
|
Mortimer A, Harding J, Roach H, Callaway M, Virjee J. Jejunal diverticulitis: an unusual cause of an intra-abdominal abscess - coronal Computed Tomography reconstruction can aid the diagnosis. J Radiol Case Rep 2008; 2:15-8. [PMID: 22470605 DOI: 10.3941/jrcr.v2i5.85] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Jejunal diverticulitis is a rare condition that can present with an acute abdomen and be referred for imaging. We present the case of an elderly patient who at CT was diagnosed with an intra-abdominal abscess involving both jejunum and transverse colon. However, the underlying eitiology was not initially clear until small bowel barium follow-through.Pertinent points regarding CT findings in jejunal diverticulitis are discussed, and practical recommendations in small bowel diverticulum recognition and diagnosis are made.
Collapse
Affiliation(s)
- Alex Mortimer
- Severn School of Radiology, Bristol Royal Infirmary, Bristol, UK
| | | | | | | | | |
Collapse
|
41
|
Levine MS, Rubesin SE, Laufer I. Pattern Approach for Diseases of Mesenteric Small Bowel on Barium Studies. Radiology 2008; 249:445-60. [DOI: 10.1148/radiol.2491071336] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
42
|
Abstract
OBJECTIVE The purpose of our study was to better characterize the CT findings of jejunal diverticulosis by retrospectively reviewing abdominal CT scans of 28 patients with this condition on barium examinations. CONCLUSION Jejunal diverticula have characteristic findings on CT, appearing as discrete round or ovoid, contrast-, fluid-, or air-containing structures outside the expected lumen of the small bowel, with a smooth, barely discernible wall and no recognizable small-bowel folds. Not infrequently, these structures are seen to communicate directly with an adjoining small-bowel loop, a feature best recognized by scrolling the images. Our experience suggests that jejunal diverticulosis can often be recognized on the basis of the characteristic CT features of this condition.
Collapse
|
43
|
Raina A, Kiss L, Yadav D. Electronic clinical challenges and images in GI. Ileal diverticulitis. Gastroenterology 2008; 134:e5-7. [PMID: 18486615 DOI: 10.1053/j.gastro.2008.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Amit Raina
- Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | | |
Collapse
|
44
|
Abstract
Meckel's diverticulum is the most common congenital gastrointestinal anomaly, and 2-4% of patients with a Meckel's diverticulum will subsequently develop complications, including intestinal hemorrhage, intestinal obstruction, and diverticulitis. Meckel's diverticulitis is infrequently included in the differential diagnosis of abdominal pain in older adults. We present a case of Meckel's diverticulitis in a 74 year-old male who presented with non-specific abdominal pain and angina. Here, multi-detector computed tomography (MD-CT) imaging provided a pre-operative diagnosis of Meckel's diverticulitis. We then offer a review of the epidemiology, anatomy, radiologic findings, and differential diagnosis of Meckel's diverticulitis. This case presents coronal and sagittal MD-CT reconstructions of Meckel's diverticulitis that have yet to be well-described in the literature.
Collapse
|
45
|
Braun C, Püschel K, Schulz F. Tödlicher Verlauf einer Dünndarmdivertikulitis. Rechtsmedizin (Berl) 2007. [DOI: 10.1007/s00194-007-0442-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
46
|
Sermoneta D, di Mugno M, Pierconti F, Gui D. Acquired poststenotic jejunal diverticulosis. Dig Dis Sci 2007; 52:1360-3. [PMID: 17372832 DOI: 10.1007/s10620-006-9264-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Accepted: 02/13/2006] [Indexed: 12/09/2022]
Affiliation(s)
- Daniel Sermoneta
- Department of Surgical Sciences, Catholic University of the Sacred Heart, Rome, Italy.
| | | | | | | |
Collapse
|
47
|
Liu CH, Huang KW, Mo YH, Yang PM. Enterolith ileus in a patient with jejunal diverticulosis: sonographic findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2007; 35:169-73. [PMID: 17295273 DOI: 10.1002/jcu.20246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Jejunal diverticula are rare. Enterolith ileus, the least-encountered complication among patients with jejunal diverticula, is incidentally found at surgery or during imaging studies such as radiography, CT, or endoscopy. We report the case of a 71-year-old man with enterolith ileus involving the jejunum that was initially detected using abdominal sonography and subsequently confirmed with abdominal CT and surgery. Enterolith ileus should be considered in the differential diagnosis of small bowel obstruction. Abdominal sonography may contribute to the early diagnosis of this condition.
Collapse
Affiliation(s)
- Chen-Hua Liu
- Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, 579, Section 2, Yun-Lin Road, Dou-Liu City, Yun-Lin County, Taiwan
| | | | | | | |
Collapse
|
48
|
Sinha R. Jejunal diverticulosis: sonographic diagnosis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2006; 34:84-7. [PMID: 16547978 DOI: 10.1002/jcu.20206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
We report the sonographic appearance of jejunal diverticulosis in 4 cases. Jejunal diverticula appear as multiple peri-intestinal hypoechoic structures on sonographic examination. Many diverticula show communication with the bowel lumen. The diverticular neck formed by the prolapsed mucosal and submucosal layers can be seen as a parallel, echogenic structure traversing the bowel wall. Most diverticula also contain echogenic debris and air-related artifacts. Because jejunal diverticula may be encountered during a sonographic examination, sonologists should be aware of their sonographic appearance to prevent diagnostic errors.
Collapse
Affiliation(s)
- Rakesh Sinha
- Department of Radiology, Derby City General Hospital, Derby DE22NE, United Kingdom
| |
Collapse
|
49
|
Liu CY, Chang WH, Lin SC, Chu CH, Wang TE, Shih SC. Analysis of clinical manifestations of symptomatic acquired jejunoileal diverticular disease. World J Gastroenterol 2005; 11:5557-60. [PMID: 16222755 PMCID: PMC4320372 DOI: 10.3748/wjg.v11.i35.5557] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze systematically our experience over 22 years with symptomatic acquired diverticular disease of the jejunum and ileum, exploring the clinical manifestations and diagnosis of this rare but life-threatening disease.
METHODS: The medical records of patients with surgically confirmed symptomatic jejunoileal diverticular disease were retrospectively reviewed. Data collected included demographic data, laboratory results, clinical course (acute or chronic), preoperative diagnosis, and operative findings. Inclusion criteria were as follows: (1) surgical confirmation of jejunoileal diverticular disease and (2) exclusion of congenital diverticula (e.g. Meckel’s diverticulum).
RESULTS: From January 1982 to July 2004, 28 patients with a total of 29 operations met the study criteria. The male:female ratio was 14:14, and the mean age was 62.6±3.5 years. The most common manifestation was abdominal pain. In nearly half of the patients, the symptoms were chronic. Two patients died after surgery. Only four cases were correctly diagnosed prior to surgery, three by small bowel series.
CONCLUSION: Symptomatic acquired small bowel diverticular disease is difficult to diagnose. It should be considered in older patients with unexplained chronic abdominal symptoms. A small bowel series may be helpful in diagnosing this potentially life-threatening disease.
Collapse
Affiliation(s)
- Chia-Yuan Liu
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Section 2, Chung-San North Road, Taipei, Taiwan, China
| | | | | | | | | | | |
Collapse
|
50
|
Abstract
The purpose of this study was to evaluate the relationship of large diverticulum (>3 cm) and volvulus of the small bowel (SB) in adults. A computer search of the medical records between January 1995 and December 2002 revealed 94 surgically proved cases of small bowel volvulus in adults. We reviewed the surgical records and recorded any specific condition found during laparotomy. The control group included 107 consecutive patients receiving a laparotomy with a diagnosis other than SB volvulus. In the 94 surgically proved cases of SB volvulus, the surgical records described presence of adhesion in 47 cases, adhesions around large SB diverticulum (>3 cm) in 5 cases, coexistence of large SB diverticulum and adhesions around the narrowed mesenteric root in 4 cases, large SB diverticulum without a specific description of the presence of adhesion or narrowed mesenteric root in 24 cases, narrowed mesenteric root without large SB diverticulum in 3 cases, internal hernia in 4 cases, tumors in 3 cases, and absence of any specific lesion in 4 cases. Only one case was found to have a large SB diverticulum in the control group. The incidence of large SB diverticulum in SB volvulus of adults was 35% (33/94), significantly higher than that of the control group (1%, 1/107) (p < 0.01). Large diverticulum of the small bowel might play a contributing role in the occurrence of SB volvulus in adults.
Collapse
Affiliation(s)
- Chung Kuao Chou
- Department of Radiology, Chi-Mei Medical Center, 901 Chung Hwa Road, 71010 Tainan, Taiwan, Republic of China.
| | | | | | | |
Collapse
|