• GI bleeding
• Gastrointestinal surgery
• Gastrointestinal system
• Small intestine

• Humans
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/therapy
• Jejunal Diseases/diagnosis
• Jejunal Diseases/complications
• Jejunal Diseases/surgery
• Diverticulum/complications
• Diverticulum/diagnosis
• Diverticulum/diagnostic imaging
• Male
• Aged
• Female
• Tomography, X-Ray Computed
• Diagnosis, Differential

• malrotation
• mesenteric ischaemia
• mid gut volvulus
• small bowel diverticulosis
• surgical anastomosis

• Acute care surgery
• Anastomosis
• Anastomotic leakage
• Emergency surgery
• Laparotomy
• Peritonitis

• Animals
• Humans
• Anastomosis, Surgical
• Anastomotic Leak/surgery
• Enterostomy
• Peritonitis/etiology
• Peritonitis/surgery
• Retrospective Studies

• Small intestine < Gastroenterology < CLINICAL
• gastrointestinal surgery < Surgery < CLINICAL
• general surgery < Surgery < CLINICAL

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.

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.

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.

• Case report
• Complicated small intestinal diverticulosis
• Diverticulectomy
• Jejunal diverticulum perforation
• Review article
• Small bowel diverticula

• bowel resection
• complicated diverticulitis
• diverticular disease
• jejunal diverticulum
• perforation

A 71-year-old male with a past medical history significant for chronic constipation presented to the emergency department for acute onset of severe abdominal pain. On presentation, the patient appeared to be in distress, exemplifying signs of peritonitis despite vital signs being grossly benign. CT scan established the diagnosis of a perforated jejunal diverticulitis. Initially, the patient was managed conservatively with IV fluids, antibiotics, and pain control medications. Diagnostic imaging in tandem with the patient's failure to improve incited surgical intervention with a jejunal resection and establishment of a primary anastomosis. This case illustrates additional differential diagnoses necessary for consideration in an elderly patient presenting with an acute abdomen. 

• diverticular disease
• dysmotility
• intraluminal pressure
• jejunal diverticulitis
• jejunal perforation
• peritonitis
• small bowel diverticulosis

• Acute abdomen
• Jejunal diverticulosis
• Perforation
• Primary repair

• Bowel obstruction
• Computed tomography
• Diverticula
• Diverticular hemorrhage
• Diverticulitis
• Small bowel

• Diagnosis, Differential
• Diverticular Diseases/complications
• Diverticular Diseases/diagnostic imaging
• Humans
• Jejunal Diseases/complications
• Jejunal Diseases/diagnostic imaging
• Tomography, X-Ray Computed

•

Multiple diverticulosis of the jejunum constitutes an uncommon pathology of the small bowel.

Multiple diverticulosis of the jejunum constitutes an uncommon pathology of the small bowel. The disease is often asymptomatic and must be taken into consideration in cases of unexplained malabsorption, anemia, chronic abdominal pain and discomfort.

We are thereby reporting a 50 yr patient on chronic NSAID ingestion presenting to us with acute abdomen. On exploration, there were multiple (14) jejunal diverticuli on both mesenteric and antimesentric border from 10 cm to 90 cm distal to duedenojejunal junction with a perforation in one of the diverticulum, 80 cm distal to the ligament of Treitz. We performed a resection of a 80-cm jejunal segment involving the multiple diverticula and an end to end jejunojejunostomy.

Drug-induced jejunal perforation is known, but jejunal diverticular perforation related to steroid/treatment has been reported only once previously. Long-term NSAID therapy usually induces clinically silent enteropathy characterized by increased intestinal permeability and inflammation. Jejunal diverticulosis is a challenging disorder from a diagnostic perspective, with no truly reliable diagnostic tests. The current treatment of choice for perforated jejunal diverticula causing generalized peritonitis is prompt laparotomy with segmental intestinal resection and primary anastomosis.

Jejunal diverticula are rare lesions, and their perforation never features in the list of diagnoses for acute abdomen, especially in this part of the world. Further this unique case report opens the doors for further research to prove an assosiation between NSAID use and diverticular perforation which itself is a very rare entity.

• Anastomosis
• Diverticula
• Jejunum
• Laparotomy
• NSAID
• Perforation
• Segmental resection

• Diverticulitis
• Inflammatory bowel disease
• MR enteroclysis
• MR enterography
• Small bowel disease

Small bowel volvulus, which is torsion of the small bowel and its mesentery, is a medical emergency, and is categorized as primary or secondary type. Primary type often occurs without any apparent intrinsic anatomical anomalies, while the secondary type is common clinically and could be caused by numerous factors including postoperative adhesions, intestinal diverticulum, and/or tumors. Here, we report a rare case of a 60-year-old man diagnosed with small bowel volvulus using multidetector computed tomography (MDCT) angiography. Further discovery by laparotomy showed one jejunal diverticulum, longer corresponding mesentery with a narrower insertion, and a lack of mesenteric fat. This case report includes several etiological factors of small bowel volvulus, and we discuss the possible cause of small bowel volvulus in this patient. We also highlight the importance of MDCT angiography in the diagnosis of volvulus and share our experience in treating this disease.

• Small bowel volvulus
• Jejunal diverticulosis
• Laparotomy
• Laparoscopic cholecystectomy
• Fibrous adhesions

• Diverticulum/complications
• Diverticulum/diagnosis
• Diverticulum/surgery
• Humans
• Intestinal Volvulus/diagnosis
• Intestinal Volvulus/etiology
• Intestinal Volvulus/surgery
• Jejunal Diseases/complications
• Jejunal Diseases/diagnosis
• Jejunal Diseases/surgery
• Male
• Middle Aged
• Multidetector Computed Tomography
• Predictive Value of Tests
• Risk Factors
• Treatment Outcome

Small bowel diverticulum is a rare cause of gastrointestinal bleeding. The diagnosis and treatment of small bowel diverticular hemorrhage is clinically challenging before the development of deep enteroscopy. In this multicenter study from the Taiwan Association for the Study of Small Intestinal Diseases (TASSID), 608 patients underwent deep enteroscopy for obscure gastrointestinal bleeding during January 2004 and April 2010 from eight medical centers in Taiwan. Small bowel diverticular hemorrhage account for 7.89% of obscure gastrointestinal bleeding in this study. Most of the patients received endoscopic therapy with an initial hemostasis rate of 85.71% and rebleeding rate of 20%. In this large case series investigating the enteroscopic management of small intestinal diverticular hemorrhage, we found that, as to patients with peptic ulcer hemorrhage, most of these patients can be successfully managed by endoscopic therapy before surgery in the era of deep enteroscopy.

This report details the management of a patient with perforated acute diverticulitis of the Roux-en-Y loop 4 years after bariatric surgery.

We report a rare case of complicated jejunal diverticulitis in a patient with previous bariatric surgery. Small bowel diverticulosis is generally considered an inoffensive disease. In this report we describe a case of small bowel perforation in an obese subject who had undergone laparoscopic Roux-en-Y gastric bypass.

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.

• Jejunal diverticulosis
• Midgut volvulus
• Intestinal obstruction
• Computed tomography
• Surgery

AIM: To study and provide data on the evolution of medical procedures and outcomes of patients suffering from perforated midgut diverticulitis.

METHODS: Three data sources were used: the Medline and Google search engines were searched for case reports on one or more patients treated for perforated midgut diverticulitis (Meckel’s diverticulitis excluded) that were published after 1995. The inclusion criterion was sufficient individual patient data in the article. Both indexed and non-indexed journals were used. Patients treated for perforated midgut diverticulitis at Vestfold Hospital were included in this group. Data on symptoms, laboratory and radiology results, treatment modalities, surgical access, procedures, complications and outcomes were collected. The Norwegian patient registry was searched to find patients operated upon for midgut diverticulitis from 1999 to 2007. The data collected were age, sex, mode of access, surgical procedure performed and number of patients per year. Historical controls were retrieved from an article published in 1995 containing pertinent individual patient data. Statistical analysis was done with SPSS software.

RESULTS: Group I: 106 patients (48 men) were found. Mean age was 72.2 ± 13.1 years (mean ± SD). Age or sex had no impact on outcomes (P = 0.057 and P = 0.771, respectively). Preoperative assessment was plain radiography in 53.3% or computed tomography (CT) in 76.1%. Correct diagnosis was made in 77.1% with CT, 5.6% without (P = 0.001). Duration of symptoms before hospitalization was 3.6 d (range: 1-35 d), but longer duration was not associated with poor outcome (P = 0.748). Eighty-six point eight percent of patients underwent surgery, 92.4% of these through open access where 90.1% had bowel resection. Complications occurred in 19.2% of patients and 16.3% underwent reoperation. Distance from perforation to Treitz ligament was 41.7 ± 28.1 cm. At surgery, no peritonitis was found in 29.7% of patients, local peritonitis in 47.5%, and diffuse peritonitis in 22.8%. Peritonitis grade correlated with the reoperation rate (r = 0.43). Conservatively treated patients had similar hospital length of stay as operated patients (10.6 ± 8.3 d vs 10.7 ± 7.9 d, respectively). Age correlated with hospital stay (r = 0.46). No difference in outcomes for operated or nonoperated patients was found (P = 0.814). Group II: 113 patients (57 men). Mean age 67.6 ± 16.4 years (range: 21-96 years). Mean age for men was 61.3 ± 16.2 years, and 74.7 ± 12.5 years for women (P = 0.001). Number of procedures per year was 11.2 ± 0.9, and bowel resection was performed in 82.3% of patients. Group III: 47 patients (21 men). Patient age was 65.4 ± 14.4 years. Mean age for men was 61.5 ± 17.3 years and 65.3 ± 14.4 years for women. Duration of symptoms before hospitalization was 6.9 d (range: 1-180 d). No patients had a preoperative diagnosis, 97.9% of patients underwent surgery, and 78.3% had multiple diverticula. Bowel resection was performed in 67.4% of patients, and suture closure in 32.6%. Mortality was 23.4%. There was no difference in length of history or its impact on survival between Groups I and III (P = 0.241 and P = 0.198, respectively). Resection was more often performed in Group I (P = 0.01). Mortality was higher in Group III (P = 0.002).

CONCLUSION: In cases with contained perforation, conservative treatment gives satisfactory results, laparoscopy with lavage and drainage can be attempted and continued with a conservative course.

• Intestinal
• Small bowel
• Jejunum
• Ileum
• Perforation
• Diverticulitis
• Conservative treatment

A seventy-year-old male presented with severe myasthenia gravis and an episode of obscure bleeding. There was a history of gastric ulcer leading to Billroth II surgery twenty-five years ago. Upper endoscopy revealed no pathology. Colonoscopy showed a few solitary diverticula and traces of old blood in the terminal ileum. Capsule endoscopy pictured red smear in the upper jejunum. Diverticula were seen as well. Suspecting bleeding jejunal diverticulosis double balloon enteroscopy was performed. The complete jejunal ascending loop and about 100 cm of the jejunum through the descending jejunal loop could be inspected. Large diverticula with fecoliths were found in both loops. Bleeding had ceased. The patient was discharged to neurology for optimizing therapy for myasthenia gravis.

We present a case of small bowel diverticulum with gastrointestinal stromal tumor (GIST). This GIST in the diverticulum was confirmed by immunohistochemistry and was of low-grade malignant potential.

• Acute abdomen
• Diverticulitis
• Jejunal diverticulosis

Jejunal diverticulosis is a rare entity with variable clinical and anatomical presentations. Its reported incidence varies from 0.05% to 6%. Although there is no consensus on the management of asymptomatic jejunal diverticular disease, some complications are potentially life threatening and require early surgical treatment. We report a case of an 88-year-old man investigated for acute abdominal pain with a high biological inflammatory syndrome. Inflammation of multiple giant jejunal diverticulum was discovered at abdominal computed tomography (CT). As a result of the clinical and biological signs of early peritonitis, an emergency surgical exploration was performed. The first jejunal loop showed clear signs of jejunal diverticulitis. Primary segmental jejunum resection with end-to-end anastomosis was performed. Histopathology report confirmed an ulcerative jejunal diverticulitis with imminent perforation and acute local peritonitis. The patient made an excellent rapid postoperative recovery. Jejunal diverticulum is rare but may cause serious complications. It should be considered a possible etiology of acute abdomen, especially in elderly patients with unusual symptomatology. Abdominal CT is the diagnostic tool of choice. The best treatment is emergency surgical management.

• Jejunal diverticulum
• Diverticulitis
• Surgery
• Tomography

Small bowel diverticulosis represents an uncommon disorder (except for Meckel diverticulum) often misdiagnosed since it causes non-specific gastroin-testinal symptoms. Most of times the diagnosis is carried out in case of related complications, such as diverticulitis, hemorrhage, perforation or obstruction. Intestinal obstruction can be caused by inflammatory stenosis due to repeated episodes of diverticulitis, volvulus, intussusception or jejunal stones. Herein we report a case of multiple jejunal diverticula causing chronic gastrointestinal obstruction.

• Jejunal diverticula
• Chronic symptoms
• Gastrointestinal obstruction
• Jejunal resection

• Abdomen, Acute/diagnosis
• Abdomen, Acute/etiology
• Abdomen, Acute/therapy
• Anti-Bacterial Agents/therapeutic use
• Clinical Laboratory Techniques
• Diagnostic Imaging
• Humans
• Intestinal Perforation/diagnosis
• Intestinal Perforation/etiology
• Intestinal Perforation/therapy
• Physical Examination
• Pneumoperitoneum/etiology
• Postoperative Care

Small intestine diverticulosis is a rare entity that is asymptomatic in the majority of cases. However, it may cause serious complications, such as infection, hemorrhage, intestinal obstruction and diverticulitis. Kayexalate (sodium polystyrene sulfonate) in sorbitol has been associated with colonic necrosis and less frequently with upper gastrointestinal injuries in a subset of uremic patients treated for hyperkalemia. We report a case of jejunal diverticulosis with mucosal injury and diverticulitis in a uremic patient treated with Kayexalate and discuss the potential role of Kayexalate in the pathogenesis of diverticulitis.

• Diverticulitis
• Jejunal diverticulosis
• Kayexalate

• Aged
• Anastomosis, Roux-en-Y
• Constriction, Pathologic/complications
• Constriction, Pathologic/etiology
• Diverticulum/etiology
• Diverticulum/pathology
• Diverticulum/surgery
• Humans
• Intestinal Obstruction/complications
• Intestinal Obstruction/etiology
• Intestinal Obstruction/physiopathology
• Jejunal Diseases/etiology
• Jejunal Diseases/pathology
• Jejunal Diseases/surgery
• Jejunostomy/adverse effects
• Jejunostomy/methods
• Male
• Pressure
• Treatment Outcome

• Anastomosis, Surgical
• Aphasia/etiology
• Caustics/poisoning
• Diverticulum/surgery
• Esophagoplasty/methods
• Esophagus/injuries
• Esophagus/surgery
• Humans
• Hydrochloric Acid/poisoning
• Jejunal Diseases/surgery
• Jejunum/transplantation
• Male
• Middle Aged
• Suicide, Attempted
• Time Factors