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Bangeas P, Konstantinidis N, Chrisopoulou T, Karatzia D, Giakoustidis A, Papadopoulos VN. Small Bowel Diverticulosis and COVID-19: Awareness Is the Key: A Case Series and Review of the Literature. Medicina (Kaunas) 2024; 60:229. [PMID: 38399517 PMCID: PMC10890375 DOI: 10.3390/medicina60020229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/25/2024]
Abstract
Small bowel non-Meckelian diverticulosis is a rare condition with only a few published cases despite being described over 200 years ago. In the midst of the COVID-19 pandemic, studies suggested that many patients may experience gastrointestinal manifestations. Intestinal symptoms could worsen the inflammation and infection associated with small bowel diverticulitis. Here we present three cases: one with inflammation and rupture in a COVID-19 patient and another as an asymptomatic detection. The third case involved recurrence after the first laparoscopic lavage approach. Furthermore, we provide a mini-review of the literature to emphasize the importance of considering this entity in the differential diagnosis of an acute abdomen. In the majority of cases involving small bowel diverticula, conservative management is the preferred approach. However, when complications arise, surgical intervention, including enteroctomy and primary anastomosis, may be necessary to achieve optimal outcomes.
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Affiliation(s)
- Petros Bangeas
- 1st University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (N.K.); (D.K.); (A.G.); (V.N.P.)
- Department of Radiology, Genesis General Clinic, 54301 Thessaloniki, Greece;
| | - Nikolaos Konstantinidis
- 1st University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (N.K.); (D.K.); (A.G.); (V.N.P.)
| | - Tania Chrisopoulou
- Department of Radiology, Genesis General Clinic, 54301 Thessaloniki, Greece;
| | - Despoina Karatzia
- 1st University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (N.K.); (D.K.); (A.G.); (V.N.P.)
| | - Alexandros Giakoustidis
- 1st University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (N.K.); (D.K.); (A.G.); (V.N.P.)
| | - Vasileios N. Papadopoulos
- 1st University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (N.K.); (D.K.); (A.G.); (V.N.P.)
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Islam S, Shah A, Naraynsingh V. Isolated Perforation of Multiple Jejunal Diverticulae: A Very Rare Cause of Acute Abdomen. Cureus 2024; 16:e52228. [PMID: 38352077 PMCID: PMC10861364 DOI: 10.7759/cureus.52228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/16/2024] Open
Abstract
Isolated jejunal diverticular (JD) perforation is extremely rare; it usually presents as a diagnostic dilemma and is often discovered incidentally on laparotomy. Most of these perforations are single. Literature has revealed only one case of multiple small bowel diverticular perforations. We report the first case of simultaneous perforation of four jejunal diverticulae in an 85-year-old male. Small bowel resection and primary anastomosis were performed. The patient had an uneventful post-operative recovery. This case highlights the importance of prompt diagnosis and timely management to reduce the morbidity and mortality of these patients. It should be included in the differential diagnosis in all elderly patients presenting with acute abdomen.
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Affiliation(s)
- Shariful Islam
- General Surgery/Oncoplastic Breast Surgery, San Fernando General Hospital, San Fernando, TTO
- Clinical Surgical Sciences, University of the West Indies, St. Augustine, TTO
| | - Aneela Shah
- General Surgery, San Fernando General Hospital, San Fernando, TTO
| | - Vijay Naraynsingh
- Clinical Surgical Sciences, University of the West Indies, St. Augustine, TTO
- Surgery, Medical Associates Hospital, St. Joseph, TTO
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3
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Tkachuk B, Collins R, Stukalin I, Gupta M, Ng D, Jijon H. Diffuse Jejunal Lipomatosis and Associated Complications. ACG Case Rep J 2023; 10:e01179. [PMID: 37860810 PMCID: PMC10584287 DOI: 10.14309/crj.0000000000001179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/19/2023] [Indexed: 10/21/2023] Open
Abstract
Small intestinal lipomatosis is a rare condition with a poorly understood epidemiology and pathophysiology. Cases of small intestinal lipomatosis have been documented in multiple countries over the last century, yet little has been published regarding the natural history of this disease. Therapeutic options are largely surgical and based on limited evidence. We report a unique case of diffuse jejunal lipomatosis in a 62-year-old man with complications of small bowel obstruction, small bowel volvulus, jejunal diverticulosis, pneumatosis intestinalis, malnutrition, small intestinal bacterial overgrowth, and intestinal dysmotility developing over a 12-year period.
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Affiliation(s)
- Bryce Tkachuk
- Division of Internal Medicine, Department of Medicine, University of Calgary, Calgary, Canada
| | | | - Igor Stukalin
- Division of Internal Medicine, Department of Medicine, University of Calgary, Calgary, Canada
| | - Milli Gupta
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Canada
| | - Danny Ng
- Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada
| | - Humberto Jijon
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Canada
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4
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Kc M, Dahal S, Shah S, Awale L, Kansakar PBS. Jejunal diverticulum and pneumatosis intestinalis presenting as pneumoperitoneum: A case report. Int J Surg Case Rep 2023; 107:108320. [PMID: 37196478 DOI: 10.1016/j.ijscr.2023.108320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Jejunal diverticulum is a rare condition that affects less than 0.5 % of population. Pneumatosis is also a rare disorder marked by gas in the intestinal wall's submucosa and subserosa. Both the conditions are rare cause of pneumoperitoneum. PRESENTATION OF CASE A case of 64 years female presented with acute abdomen and upon investigation found to have pneumoperitoneum. Exploratory laparotomy was done and intraoperatively there was multiple jejunal diverticula and pneumatosis intestinalis in separate segments of bowel and closure was done without any resection of bowel segments. CLINICAL DISCUSSION Small bowel diverticulosis was considered to be an incidental anomaly; however, it is now thought to be acquired. Pneumoperitoneum is a common complication of diverticula perforation. The occurrence of pneumatosis cystoides intestinalis or subserosal dissection of air around the colon or adjacent structures has been linked to pneumoperitoneum. Complications should be managed accordingly however, occurrence of short bowel syndrome should be considered before doing resection anastomosis of involved segment. CONCLUSION Jejunal diverticula and pneumatosis intestinalis both are rare cause of pneumoperitoneum. Combination of both the condition giving rise to pneumoperitoneum is extremely rare. These conditions can give rise to diagnostic dilemma in clinical practice. One should always think these as differentials when patient with pneumoperitoneum are encountered.
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Affiliation(s)
- Milan Kc
- Tribhuwan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal.
| | - Suman Dahal
- Tribhuwan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Sangam Shah
- Tribhuwan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Laligen Awale
- Tribhuwan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Prasan B S Kansakar
- Tribhuwan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
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5
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Ibrahim AHM, Amer N, Alatooq HH, AlQatari AA, Abdulmomen AA. Jejunal diverticulosis: A case report. Int J Surg Case Rep 2023; 104:107946. [PMID: 36827853 PMCID: PMC9978466 DOI: 10.1016/j.ijscr.2023.107946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/22/2023] [Accepted: 02/19/2023] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION Jejunal diverticulosis is a rare entity that presents a challenging diagnosis due to its vague and non-specific clinical presentations. 40 % of the patients remain asymptomatic until the development of complications. CASE PRESENTATION We report a case of 84 years old female who presented to the hospital with vomiting and abdominal pain, found to have jejunal diverticulosis complicated by perforation in a CT scan. The patient underwent emergency expletory laparotomy with segmental intestinal resection and anastomosis. DISCUSSION The incidence of jejunal diverticulosis ranges between 3 and 5 %, with most patients discovered incidentally. Therefore, medical or surgical treatment management depends on clinical presentation and complications that necessitate surgical intervention. CONCLUSION Jejunal diverticulosis is a rare entity that commonly affects the elderly with significant morbidity and mortality; it is an important clinical entity to consider when approaching patients with acute abdomen.
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Affiliation(s)
| | - Nasser Amer
- Department of General Surgery, King Fahd University Hospital, Dammam, Saudi Arabia; College of Medicine, Imam Abdulrahamn Bin Faisal University, Dammam, Saudi Arabia.
| | | | | | - Abdulrahim Ahmed Abdulmomen
- Department of General Surgery, King Fahd University Hospital, Dammam, Saudi Arabia; College of Medicine, Imam Abdulrahamn Bin Faisal University, Dammam, Saudi Arabia
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Scheese D, Alwatari Y, Khan J, Slaughter A. Complicated jejunal diverticulitis: A case report and review of literature. Clin Case Rep 2022; 10:e6570. [DOI: 10.1002/ccr3.6570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/27/2022] [Accepted: 10/15/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Daniel Scheese
- Department of Acute Care Surgery Virginia Commonwealth University Richmond Virginia USA
| | - Yahya Alwatari
- Department of Acute Care Surgery Virginia Commonwealth University Richmond Virginia USA
| | - Jamal Khan
- Department of Acute Care Surgery Virginia Commonwealth University Richmond Virginia USA
| | - Ashley Slaughter
- Department of Acute Care Surgery Virginia Commonwealth University Richmond Virginia USA
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7
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CESTARO G, CAVALLO F, AZABDAFTARI A, FOGATO L. Different clinical presentation of jejunal diverticulitis: report of two cases. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.22.05407-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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Eqbal H, Owen A, Guest G, Watters D, Nagra S. Small bowel resection for ischemia following transcatheter arterial embolization for bleeding jejunal diverticulum: an easily forgotten complication. ANZ J Surg 2022; 93:1027-1028. [PMID: 36107114 DOI: 10.1111/ans.18042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Henna Eqbal
- Department of Surgery University Hospital Geelong Geelong Australia
| | - Andrew Owen
- Department of Radiology University Hospital Geelong Geelong Australia
| | - Glenn Guest
- Department of Surgery University Hospital Geelong Geelong Australia
| | - David Watters
- Department of Surgery University Hospital Geelong Geelong Australia
| | - Sonal Nagra
- Department of Surgery University Hospital Geelong Geelong Australia
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Zafouri EB, Ben Ismail I, Sghaier M, Rebii S, Zoghlami A. Jejunal diverticulitis: A new case report and a review of the literature. Int J Surg Case Rep 2022; 97:107395. [PMID: 35901548 PMCID: PMC9403097 DOI: 10.1016/j.ijscr.2022.107395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 02/07/2023] Open
Abstract
Jejunal diverticulitis is a rare condition. The computed tomography is now the best diagnostic imaging method. There is no consensus on therapeutic strategy and management of jejunal diverticulitis
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Affiliation(s)
- Elmontassar Belleh Zafouri
- Corresponding author at: Department of General Surgery, Trauma Center, Ben Arous, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
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Mejri A, Arfaoui K, Hedfi M, Znaidi H. Perforated jejunal diverticulum as an unsual cause of acute abdomen: A case report. Int J Surg Case Rep 2022; 94:107130. [PMID: 35658300 PMCID: PMC9079224 DOI: 10.1016/j.ijscr.2022.107130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Atef Mejri
- Department of General Surgery, Jendouba Hospital, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - Khaoula Arfaoui
- Department of General Surgery, Jendouba Hospital, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Mohamed Hedfi
- Department of General Surgery, Zaghouen Hospital, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Hakim Znaidi
- Department of General Surgery, Zaghouen Hospital, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
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11
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Mansour M, Abboud Y, Bilal R, Seilin N, Alsuliman T, Mohamed FK. Small bowel diverticula in elderly patients: a case report and review article. BMC Surg 2022; 22:101. [PMID: 35303837 PMCID: PMC8932322 DOI: 10.1186/s12893-022-01541-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Small intestine diverticula are rare findings that were mostly reported in the elderly population as asymptomatic findings. However, they can also present with a wide range of symptoms (bloating, early satiety, chronic abdominal discomfort, and diarrhea/steatorrhea) or complications (gastrointestinal bleeding, small bowel obstruction, acute diverticulitis, or perforation) which in turn warrant medical treatment or urgent surgical intervention.
Case presentation This is a case report of an 84-year-old female who presented with an acute surgical abdomen. An exploratory laparotomy revealed complicated small bowel diverticula with a jejunal diverticulum perforation, for which a diverticulectomy was performed. Conclusions Throughout this paper, we are aiming to outweigh the consideration of the possibility of complicated small bowel diverticula as a differential in the evaluation of any acute abdomen, especially in the elderly, which warrants emergency surgical management.
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Affiliation(s)
- Marah Mansour
- Faculty of Medicine, Tartous University, Tartous, Syrian Arab Republic.
| | - Yazan Abboud
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Racha Bilal
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Nour Seilin
- Department of Internal Medicine, Damascus Hospital, Damascus, Syrian Arab Republic
| | - Tamim Alsuliman
- Hematology and Cell Therapy Department, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France
| | - Fawaz K Mohamed
- Department of General Surgery, Al-Basel Hospital, Tartous, Syrian Arab Republic
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12
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Abdelhalim D, Kania T, Heldreth A, Champion N, Mukherjee I. Operative Management of Perforated Jejunal Diverticulitis. Cureus 2022; 14:e21330. [PMID: 35186588 PMCID: PMC8849253 DOI: 10.7759/cureus.21330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 11/08/2022] Open
Abstract
Small jejunal diverticulitis is very rare, presenting in 0.06% to 1.3% of the population. Many patients remain asymptomatic or have nonspecific symptoms such as malabsorption and abdominal pain, making diagnosis complicated. Up to 6% of patients present with acute perforation. Here, we present such a case involving a 69-year-old female who presented with altered mental status due to sepsis and generalized peritonitis from a perforated jejunal diverticulum that was successfully managed with definitive surgery. We highlight the importance of maintaining a broad differential, early resuscitation, and prompt surgical management in complicated jejunal diverticulitis. Although adjunctive studies such as computed tomography may be helpful in stable patients, definitive surgery was both diagnostic and therapeutic in this case.
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13
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Anjum R, Kumar N, Singla T, Mani R, Karki B. A Case of Isolated Jejunal Diverticulum Presented as Free Perforation: A Rare Cause of Acute Abdomen. Cureus 2021; 13:e18809. [PMID: 34804667 PMCID: PMC8592799 DOI: 10.7759/cureus.18809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/05/2022] Open
Abstract
Jejunal diverticulum is a very rare disease. Diagnosis of this condition is a challenge owing to non-specific complaints of the patient. Fifteen percent cases of jejunal diverticula present with acute abdomen. Approximately 77% of small bowel diverticular disease occur with multiple diverticula. Here we describe a case of complicated isolated jejunal diverticula presenting with perforation, which was successfully treated with resection of the involved segment with anastomosis.
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Affiliation(s)
- Rohik Anjum
- General Surgery, All India Institute of Medical Sciences-Rishikesh, Rishikesh, IND
| | - Navin Kumar
- General Surgery, All India Institute of Medical Sciences-Rishikesh, Rishikesh, IND
| | - Tanuj Singla
- General Surgery, All India Institute of Medical Sciences-Rishikesh, Rishikesh, IND
| | - Rishit Mani
- General Surgery, All India Institute of Medical Sciences-Rishikesh, Rishikesh, IND
| | - Bibek Karki
- General Surgery, All India Institute of Medical Sciences-Rishikesh, Rishikesh, IND
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14
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Abbasi C, Jimenez MC, Lisi M. Massive Gastrointestinal Bleeding Due to Jejunal Diverticula in a Community Hospital: A Case Report and Review of Diagnostic and Therapeutic Options. Gastroenterology Insights 2021; 12:196-201. [DOI: 10.3390/gastroent12020017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Small bowel diverticula are rare and often asymptomatic. Severe lower gastrointestinal bleeding from jejunal diverticula is rarely reported and, therefore, should be considered a differential diagnosis in all cases of lower gastrointestinal bleeding with nonconclusive gastroscopy and colonoscopy. In this case report, we discuss a case of a 75-year-old male with massive lower gastrointestinal bleeding from jejunal diverticula. Initial gastroscopy did not reveal the source of bleeding. Repeat upper endoscopy with a pediatric colonoscope identified jejunal diverticula as the likely source of bleeding. Angiography identified the site of extravasation, and successful angioembolization was done by interventional radiology.
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15
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Hardon SF, den Boer FC, Aallali T, Fransen GA, Muller S. Perforated jejunal diverticula in a young woman: A case report. Int J Surg Case Rep 2021; 81:105838. [PMID: 33887834 PMCID: PMC8050722 DOI: 10.1016/j.ijscr.2021.105838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Small bowel diverticulosis is a rare condition. It usually remains asymptomatic and undiscovered, until potentially severe complications such as diverticulitis or even perforation occur. We present an unusual case and discuss the pathophysiology, diagnostics strategies, and possible surgical intervention. CASE PRESENTATION A young woman was referred to our emergency department suffering from acute abdominal pain. A computed tomography scan showed signs of small bowel perforation of unknown origin. Exploratory laparotomy revealed multiple perforated jejunal diverticula (JD). The patient underwent segmental resection of the affected jejunum followed by primary anastomosis. Pathological examination confirmed the diagnosis of perforated JD. CONCLUSIONS Due to its rarity and variable clinical presentation, it can sometimes be challenging to diagnose this potentially life-threatening condition. If the bowel is suspected from perforation; segmental resection is the treatment of choice, preferably followed by direct restoration of the bowel continuity.
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Affiliation(s)
- Sem F Hardon
- Department of Surgery, Zaans Medical Center, Zaandam, the Netherlands; Department of Surgery, Amsterdam UMC - VU University Medical Center, Amsterdam, the Netherlands.
| | - Frank C den Boer
- Department of Surgery, Zaans Medical Center, Zaandam, the Netherlands; Department of Surgery, Amsterdam UMC - VU University Medical Center, Amsterdam, the Netherlands
| | - Tarik Aallali
- Symbiant Pathology Expert Centre, Hoorn/Zaandam, the Netherlands
| | - Gerwin A Fransen
- Department of Radiology, Zaans Medical Center, Zaandam, the Netherlands
| | - Sandra Muller
- Department of Surgery, Zaans Medical Center, Zaandam, the Netherlands
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16
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Duggan WP, Ravi A, Chaudhry MA, Ofori-Kuma F, Ivanovski I. Isolated perforated jejunal diverticulitis: a case report. J Surg Case Rep 2021; 2021:rjaa587. [PMID: 33569163 PMCID: PMC7852602 DOI: 10.1093/jscr/rjaa587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/17/2020] [Indexed: 01/17/2023] Open
Abstract
Jejunal diverticulosis is a rare phenomenon often identified either incidentally on imaging or intra-operatively. Complications of jejunal diverticulosis are associated with high rates of mortality. For this reason, it remains important that this pathology is considered amongst differentials for an acute abdomen. A 78-year old gentleman presented with a short history of generalized lower abdominal pain. Computer tomography scan revealed a large inflammatory abscess relating to a perforated jejunal diverticulum. The patient was taken to theatre where he underwent small bowel resection with primary anastomosis. Early cross sectional imaging is vital to allow early diagnosis and prompt management of this pathology. Small bowel resection with primary anastomosis was associated with an excellent clinical outcome.
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Affiliation(s)
- William P Duggan
- Department of Surgery, Wexford General Hospital, Newtown Rd, Carricklawn, Wexford Y35 Y175, Ireland
| | - Akshaya Ravi
- Department of Surgery, Wexford General Hospital, Newtown Rd, Carricklawn, Wexford Y35 Y175, Ireland
| | - Muhammad A Chaudhry
- Department of Surgery, Wexford General Hospital, Newtown Rd, Carricklawn, Wexford Y35 Y175, Ireland
| | - Felix Ofori-Kuma
- Department of Surgery, Wexford General Hospital, Newtown Rd, Carricklawn, Wexford Y35 Y175, Ireland
| | - Ivan Ivanovski
- Department of Surgery, Wexford General Hospital, Newtown Rd, Carricklawn, Wexford Y35 Y175, Ireland
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