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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: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [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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Hardon SF, den Boer FC, Aallali T, Fransen GA, Muller S. Perforated jejunal diverticula in a young woman: A case report. Int J Surg Case Rep 2021; 81:105838. [PMID: 33887834 PMCID: PMC8050722 DOI: 10.1016/j.ijscr.2021.105838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Small bowel diverticulosis is a rare condition. It usually remains asymptomatic and undiscovered, until potentially severe complications such as diverticulitis or even perforation occur. We present an unusual case and discuss the pathophysiology, diagnostics strategies, and possible surgical intervention. CASE PRESENTATION A young woman was referred to our emergency department suffering from acute abdominal pain. A computed tomography scan showed signs of small bowel perforation of unknown origin. Exploratory laparotomy revealed multiple perforated jejunal diverticula (JD). The patient underwent segmental resection of the affected jejunum followed by primary anastomosis. Pathological examination confirmed the diagnosis of perforated JD. CONCLUSIONS Due to its rarity and variable clinical presentation, it can sometimes be challenging to diagnose this potentially life-threatening condition. If the bowel is suspected from perforation; segmental resection is the treatment of choice, preferably followed by direct restoration of the bowel continuity.
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Affiliation(s)
- Sem F Hardon
- Department of Surgery, Zaans Medical Center, Zaandam, the Netherlands; Department of Surgery, Amsterdam UMC - VU University Medical Center, Amsterdam, the Netherlands.
| | - Frank C den Boer
- Department of Surgery, Zaans Medical Center, Zaandam, the Netherlands; Department of Surgery, Amsterdam UMC - VU University Medical Center, Amsterdam, the Netherlands
| | - Tarik Aallali
- Symbiant Pathology Expert Centre, Hoorn/Zaandam, the Netherlands
| | - Gerwin A Fransen
- Department of Radiology, Zaans Medical Center, Zaandam, the Netherlands
| | - Sandra Muller
- Department of Surgery, Zaans Medical Center, Zaandam, the Netherlands
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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]
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Téoule P, Birgin E, Zaltenbach B, Kähler G, Wilhelm TJ, Kienle P, Rückert F. A Retrospective, Unicentric Evaluation of Complicated Diverticulosis Jejuni: Symptoms, Treatment, and Postoperative Course. Front Surg 2015; 2:57. [PMID: 26618161 PMCID: PMC4643121 DOI: 10.3389/fsurg.2015.00057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/26/2015] [Indexed: 11/13/2022] Open
Abstract
Background In contrast to the diverticulosis of the colon, jejunal diverticulosis is a rare condition. The incidence is 0.06–5% in large autopsy series. Complicated diverticulosis jejuni (CDJ) often presents with unspecific symptoms. Therefore, diagnosis is often a challenging process and due to the clinical rarity generally valid recommendation of perioperative management does not exist. Patients and methods We considered only patients who were operated in our center between April 2007 and August 2014. Patients were identified by data bank search via International Statistical Classification of Diseases and Related Health Problems diagnosis code K57.10. Data were manually screened, and patients with Meckel’s and duodenal diverticula were excluded from this study. Eleven consecutive patients with CDJ were finally included in this study. We analyzed symptoms, diagnostic procedures, surgical treatment, and postoperative morbidity and mortality. Results The median age of our patients was 76 years (range: 34–87). CDJ presented most frequently as intestinal bleeding or as diverticulitis. Clinical symptoms were unspecific abdominal pain, hematemesis or melena, ileus, nausea, and emesis as well as patients with acute abdomen. Esophagogastroduodenoscopies confirmed CDJ in two of the three patients. An abdominal computed tomography scan only helped to diagnose CDJ in two of the 10 patients. Eight (72.7%) patients received an open segmental resection with primary anastomosis. In three (27.3%) cases, a reoperation was necessary. Overall morbidity rate was 45.5%, and perioperative mortality was 9.1%. Conclusion Due to the acute character of the disease, patients with CDJ are seriously ill. To diagnose patients with CDJ remains challenging as diagnostic investigations are usually not helpful in confirming the diagnosis. Still, diagnosis of CDJ is most frequently confirmed intraoperatively.
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Affiliation(s)
- Patrick Téoule
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University , Mannheim , Germany
| | - Emrullah Birgin
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University , Mannheim , Germany
| | - Benjamin Zaltenbach
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University , Mannheim , Germany
| | - Georg Kähler
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University , Mannheim , Germany
| | - Torsten J Wilhelm
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University , Mannheim , Germany
| | - Peter Kienle
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University , Mannheim , Germany
| | - Felix Rückert
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University , Mannheim , Germany
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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,
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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]
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Schloericke E, Zimmermann MS, Hoffmann M, Kleemann M, Laubert T, Bruch HP, Hildebrand P. Complicated jejunal diverticulitis: a challenging diagnosis and difficult therapy. Saudi J Gastroenterol 2012; 18:122-8. [PMID: 22421718 PMCID: PMC3326973 DOI: 10.4103/1319-3767.93816] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND/AIM In contrast to diverticulosis of the colon, jejunal diverticulosis is a rare entity that often becomes clinically relevant only after exacerbations occur. The variety of symptoms and low incidence make this disease a difficult differential diagnosis. PATIENTS AND METHODS Data from all patients who were treated in our surgical department for complicated jejunal diverticulitis, that is, gastrointestinal hemorrhage or a diverticula perforation were collected prospectively over a 6-year period (January 2004 to January 2010) and analyzed retrospectively. RESULTS The median age among the 9 patients was 82 years (range: 54-87). Except for 2 cases (elective operation for a status postjejunal peridiverticulitis and a re-perforation of a diverticula in a patient s/p segment resection with free perforation), the diagnosis could only be confirmed with an exploratory laparotomy. Perforation was observed in 5 patients, one of which was a retroperitoneal perforation. The retroperitoneal perforation was associated with transanal hemorrhage. Hemodynamically relevant transanal hemorrhage requiring transfusion were the reason for an exploratory laparotomy in 2 further cases. In one patient, the hemorrhage was the result of a systemic vasculitis with resultant gastrointestinal involvement. A singular jejunal diverticulum caused an adhesive ileus in one patient. The extent of jejunal diverticulosis varied between a singular diverticulum to complete jejunal involvement. A tangential, transverse excision of the diverticulum was carried out in 3 patients. The indication for segment resection was made in the case of a perforation with associated peritonitis (n=4) as well as the presence of 5 or more diverticula (n=2). Histological analysis revealed chronic pandiverticulitis in all patients. Median operating time amounted to 142 minutes (range: 65-210) and the median in-hospital stay was 12 days (range: 5-45). Lethality was 0%. Major complications included secondary wound closure after s/p repeated lavage and bilateral pleural effusions in one case. Signs of malabsorption as the result of a short bowel syndrome were not observed. Minor complications included protracted intestinal atony in 2 cases and pneumonia in one case. Median follow-up was 6 months (range: 1-18). CONCLUSION Complicated jejunal diverticulitis often remains elusive preoperatively due to its unspecific clinical presentation. A definitive diagnosis can often only be made intraoperatively. The resection of all diverticula and/or the complete diverticula-laden segment is the goal in chronic cases. The operative approach chosen (tangential, transverse excision vs segment resection) should be based on the extent of the jejunal diverticulosis as well as the intraoperative findings.
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Affiliation(s)
- Erik Schloericke
- Department of Surgery, University of Schleswig Holstein, Campus Lübeck, Luebeck, Germany.
| | - Markus S. Zimmermann
- Department of Surgery, University of Schleswig Holstein, Campus Lübeck, Luebeck, Germany
| | - Martin Hoffmann
- Department of Surgery, University of Schleswig Holstein, Campus Lübeck, Luebeck, Germany
| | - Markus Kleemann
- Department of Surgery, University of Schleswig Holstein, Campus Lübeck, Luebeck, Germany
| | - Tilman Laubert
- Department of Surgery, University of Schleswig Holstein, Campus Lübeck, Luebeck, Germany
| | - Hans-Peter Bruch
- Department of Surgery, University of Schleswig Holstein, Campus Lübeck, Luebeck, Germany
| | - Phillip Hildebrand
- Department of Surgery, University of Schleswig Holstein, Campus Lübeck, Luebeck, Germany
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Brito MCBD, Costallat BL, Martins DL, Prando A. Diverticulite jejunal: relato de caso. Radiol Bras 2011. [DOI: 10.1590/s0100-39842011000200015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Diverticulite jejunal é doença rara que acomete principalmente os idosos. Os sintomas e sinais clínicos são inespecíficos, fato que dificulta e retarda o diagnóstico. A tomografia computadorizada é muito valiosa na definição do diagnóstico. Neste relato será apresentado um caso de diverticulose jejunal complicada com diverticulite aguda perfurada bloqueada, assim como uma discussão breve sobre diverticulite jejunal e suas complicações.
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Affiliation(s)
| | | | - Daniel Lahan Martins
- Centro Radiológico Campinas; Hospital Vera Cruz, Brasil; Colégio Brasileiro de Radiologia e Diagnóstico por Imagem; Universidade Estadual de Campinas, Brasil
| | - Adilson Prando
- Hospital Vera Cruz, Brasil; Colégio Brasileiro de Radiologia e Diagnóstico por Imagem; Centro Radiológico Campinas
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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.
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Abstract
Small bowel diverticulitis is rare and there are no known guidelines for treatment. We present three cases, in which a laparotomy was performed twice and one in which conservative treatment was applied. Clinical presentations were of acute abdomen, one of which initially thought to be a ruptured aneurysm. Computed tomography scanning was the imaging modality used to make an accurate diagnosis in one case. Treatment was either by means of surgery or conservative treatment with antibiotics, bowel rest and parenteral alimentation. The possibility of conservative treatment, in the absence of perforation, is discussed.
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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.
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Affiliation(s)
- Alex Mortimer
- Severn School of Radiology, Bristol Royal Infirmary, Bristol, UK
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Graña L, Pedraja I, Mendez R, Rodríguez R. Jejuno-ileal diverticulitis with localized perforation: CT and US findings. Eur J Radiol 2008; 71:318-23. [PMID: 18555632 DOI: 10.1016/j.ejrad.2008.04.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2008] [Revised: 04/12/2008] [Accepted: 04/22/2008] [Indexed: 12/16/2022]
Abstract
PURPOSE To describe the computed tomography and ultrasound findings of five cases of small bowel diverticulitis with localized perforation. MATERIAL AND METHODS Our database, from April 2003 to August 2007, was reviewed and five cases of small bowel diverticulitis were identified. RESULTS Jejuno-ileal diverticulitis with covered perforation usually presents as wall thickening of a small bowel loop and an adjacent inflammatory mass containing air bubbles. CONCLUSION Small bowel diverticula are rare and mostly asymptomatic. They become clinically relevant when complications arise, such as diverticulitis. The symptoms of jejuno-ileal diverticulitis are non-specific and the diagnosis is performed mainly by imaging studies.
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Affiliation(s)
- Lucía Graña
- Department of Diagnostic Imaging, Hospital Clínico San Carlos, Profesor Martín Lagos, 28040 Madrid, Spain.
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13
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Affiliation(s)
- C I Buis
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Kassahun WT, Fangmann J, Harms J, Bartels M, Hauss J. Complicated small-bowel diverticulosis: A case report and review of the literature. World J Gastroenterol 2007; 13:2240-2. [PMID: 17465510 PMCID: PMC4146853 DOI: 10.3748/wjg.v13.i15.2240] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [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
While jejunoileal diverticula are rare and often asymptomatic, they may lead to chronic non-specific or acute symptoms. The large majority of complications present with an acute abdomen similar to appendicitis, cholecystitis or colonic diverticulitis but they also may appear with atypical symptoms. As a result, diagnosis of complicated jejunoileal diverticulosis can be quite difficult, and may solely depend on the result of surgical exploration. In the absence of contra-indications, diagnostic laparoscopy has the benefit of thorough examination of the abdominal contents and helps to reach an absolute diagnosis. Surgical resection of the involved small-bowel segment with primary anastomosis is the preferred treatment in patients with symptomatic complicated jejunoileal diverticular disease. An atypical presentation of complicated jejunal diverticulitis in conjunction with sigmoid diverticulitis diagnosed with laparoscopy and treated with surgical resection is presented.
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Affiliation(s)
- Woubet T Kassahun
- University of Leipzig, Faculty of Medicine, Clinic for Visceral, Transplantation, Thoracic and Vascular Surgery, OKL, Liebig Strasse 20a, 04103 Leipzig, Germany.
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Kubota T. Perforated jejunal diverticulitis. Am J Surg 2007; 193:486-7. [PMID: 17368295 DOI: 10.1016/j.amjsurg.2006.06.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Revised: 06/13/2006] [Accepted: 06/13/2006] [Indexed: 12/16/2022]
Affiliation(s)
- Tadao Kubota
- Department of Surgery Chibanishi General Hospital Chiba, 107-1 Kanegasaku Matsudo, Chiba, 270-2251 Japan.
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Quiles AM, Rodríguez-Hermosa JI, Ortiz MR, Febrer M. [Perforated jejunal diverticulitis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2006; 29:432-3. [PMID: 16938262 DOI: 10.1157/13091458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Coulier B, Maldague P, Bourgeois A, Broze B. Diverticulitis of the small bowel: CT diagnosis. ACTA ACUST UNITED AC 2006; 32:228-33. [PMID: 16967251 DOI: 10.1007/s00261-006-9045-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Accepted: 05/15/2006] [Indexed: 12/15/2022]
Abstract
In contrast with their colonic equivalents, noncolonic diverticula of the gastro-intestinal tract are much rarer and an uncommon site of inflammation. Symptoms and signs are generally nonspecific and before the advent and development of CT, clinical and radiological diagnosis was very difficult. As a result laparotomy was carried out in most cases without correct preoperative diagnosis. We report three rare cases of noncolonic diverticulitis, respectively, affecting the duodenum, the jejunum, and the distal ileum. MDCT with multiplanar reconstructions revealed unambiguously diagnostic features in the three cases and allowed minimally invasive endoscopic drainage in the duodenal case and successful conservative medical treatment in the jejunal and ileal cases. We discuss and review the prevalence, physiopathology, symptoms, and complications of diverticula of the duodenum and jejuno-ileum and emphasis on the high performance of MDCT for the diagnosis of acute diverticular complications.
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Affiliation(s)
- Bruno Coulier
- Department of Radiology, Clinique Saint Luc, Bouge, Namur, Belgium.
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Fuerxer F, Brunner P, Perrin H, Mourou MY, Bruneton JN. Acquired complicated diverticulum of the ileum. Clin Imaging 2005; 29:423-5. [PMID: 16274896 DOI: 10.1016/j.clinimag.2005.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2005] [Accepted: 04/08/2005] [Indexed: 12/01/2022]
Abstract
The complicated diverticula of the ileum are a rare cause of an acute abdomen. We report on a case in whom the CT imaging leads to the surgical removal of the ileocecal segment.
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Affiliation(s)
- Françoise Fuerxer
- Départment d'Imagerie Médicale du Centre Hospitalier Princess Grace, 98000 Monaco, France.
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García JP, Fuentes FT, Pérez Díaz M, Sánchez MS. Diverticulitis de yeyuno perforada. GASTROENTEROLOGIA Y HEPATOLOGIA 2002. [DOI: 10.1016/s0210-5705(02)70305-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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