Perforated jejunal diverticulitis fulltext case reports in. Herewith, we are presenting a very rare case of jejunal diverticulosis with complication, noted at a tertiary care hospital in southern india. The disorder seems to be mostly acquired, but two families with extensive jejunal diverticulosis have been published in 1988 and 2007 1, 2. May 25, 2007 surgical management of small bowel diverticulosis was first described in 1906 by gordinier and sampson. The occurrence of complicated diverticular disease is common among the elderly. Jejunoileal diverticulosis, a rare cause of ileal perforation case report.
Clinical presentation is characterized with pain in the upper left quadrant of the. Feb 11, 2017 diverticulosis and diverticular disease slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Although it is frequently seen in duodenum, jejunal and ileal locations are very rare. Complicated smallbowel diverticulosis is a rather uncommon cause of upper abdominal pain. However, they may cause chronic nonspecific symptoms or rarely lead to an acute presentation.
Resection of the involved area with primary jejunojejunal anastomosis is the surgical management of choice in the presence of perforated jejunal diverticular disease, hemorrhage, or abscess formation after a failure of a short course of bowel rest and antibiotics 4. Jejunal diverticular perforation with intraabdominal abscess. Surgical resection should be as limited as possible in case of extensive jejunal diverticulosis, to avoid short bowel syndrome. Diverticulosis of the jejunum is a rare condition with an incidence ranging from 0. Duodenal and meckel diverticulum excluded, small bowel diverticula are most common in the proximal jejunum. Jejunal diverticula are an uncommon acquired disease that is usually silent and asymptomatic. The authors report a case of jejunal diverticulitis that was initially treated with medical management but eventually required surgical intervention. Given the high mortality rate of jejunal diverticulitis, a precise diagnosis followed by appropriate therapeutic intervention is essential. Perforation of jejunal diverticulum is difficult to diagnose due to localized peritonitis and requires urgent surgical intervention. In summary, we present a case of multiple jejunal diverticula with jejunal volvulus. Jejunal diverticulosis is a rare condition with variable clinical and anatomical presentations. Jejunal perforation with intraabdominal abscess formation of jejunal diverticula is a rare complication.
The aim of this study is to present the clinical course. The clinical manifestations, diagnosis, and management of meckels diverticulum, the epidemiology and pathophysiology of colonic diverticular disease, the treatment of diverticulitis, and. They are acquired false diverticulae pseudodiverticuli which arise due to outpouching of mucosa and muscularis mucosa through the muscle coat at the point where the mesenteric vessels penetrate intestinal wall. Diverticulosis and diverticular disease slideshare.
Jejunal diverticulosis is usually asymptomatic, and uncomplicated jejunal diverticulosis does not need any surgical intervention. Nov 03, 2010 jejunoileal diverticulosis and its associated complications are rare. While most cases are asymptomatic, 3040% of the cases may become symptomatic with chronic abdominal pain, malabsorption, hemorrhage, diverticulitis, obstruction. Other modalities of diagnosing jejunal diverticula include wireless capsule endoscopy and small bowel.
However, they can present with a number of acute and emergent complications with a high. We report the case of an 82yearold caucasian woman presenting with a oneday history of generalized abdominal pain, with three episodes of vomiting. Ct scan demonstrates jejunal diverticulosis and wall thickening on a jejunum segment associated with inflammatory blurring of fat planes around and keeping intimate contact with the sigmoid colon, which has diverticular disease also. If you continue browsing the site, you agree to the use of cookies on this website. Jejunal diverticulosis is a rare entity with a reported clinical incidence of 0. Jejunoileal diverticulitis radiology reference article. Diverticulosis of the jejunum, generally considered to be an asymptomatic condition, may produce a variety of interesting clinical and pathophysiologic syndromes which are correctable by surgical intervention. As the presentation is often similar to other pathologies acute appendicitis, pancreatitis, or acute cholecystis and in many cases diagnosis is made on basis of surgical findings, careful analysis of the.
Jejunal diverticular perforation causing small bowel. To report two patients presenting with an acute abdomen caused by acute jejunal diverticulitis who were treated nonsurgically as opposed to surgically as the. The literature estimates that jejunal diverticulosis has an incidence of 0. There is a thickened loop of jejunum with moderate degree of fat stranding affecting the associated mesentery. Oct 01, 2019 small intestinal diverticulosis refers to the clinical entity characterized by the presence of multiple saclike mucosal herniations through weak points in the intestinal wall. We report a case of massive gastrointestinal bleeding from an arteriovenous malformation avm within a jejunal diverticulum to underscore the significance of such coexisting pathologies. We report a case of perforated jejunal diverticulum presented with a 6month history of significant weight loss and acute abdominal pain.
Surgical treatment of giant small bowel diverticula with acute. We hereby report a 52 year old male with perforated jejunal diverticula. Although there is no consensus on the management of asymptomatic jejunal diverticular disease, some complications are potentially life threatening and require early surgical treatment. Case report open access massive rectal bleeding from. As the presentation is often similar to other pathologies acute. However, significant bleeding in the setting of few diverticulae is very unusual and rare. Jejunal diverticular perforation with intraabdominal. Small intestinal diverticula are far less common than colonic diverticula. Jejunal diverticula are false diverticula with projections of mucosa and serosa without the muscular layer. Jejunoileal diverticula, also referred to as jejunal diverticula or diverticulosis as most of the diverticula are located in the jejunum, are outpouchings from the jejunal and ileal wall on their mesenteric border that represent mucosal herniation through sites of wall weakening 1 jejunoileal diverticulitis is much rarer than colonic diverticulitis. Related complications such as diverticulitis, perforation, bleeding or intestinal obstruction appear in 1030% of the patients increasing. Jejunal diverticulosis is very uncommon in individuals less than 40 years of age and thus incidence of jejunal diverticular disease in childhood has not been reported to date. She is still on hemodialysis program with routine control visits to the nephrology.
Perforation of jejunal diverticulum is quite uncommon. The clinical presentation of diverticulosis depends on. The typical presentation of jejunal diverticula is intermittent. The cause of inflammation is the same as colonic diverticulitis, and thus treatment is basically the same. Jejunal diverticular disease complicated by enteroliths. It may lead to symptoms presenting with an acute onset or to chronic and nonspecific complaints. The prevalence of the disorder on autopsy ranges 0. Jejunal diverticulosis with enterolith presenting as acute. In the small bowel, duodenum is the most common site of diverticulosis followed by the jejunum and the ileum. Ct scan can be helpful in diagnosis of jejunal diverticula. Asymptomatic diverticular disease is best managed by fiberenriched diet 30 g of fiberd avoid nuts and popcorn. Little is known about diverticulosis of the small bowel. Arteriovenous malformations within jejunal diverticulosis. Resection of involved gut with end to end jejuno jejunal anastomosis was done.
This report defines the clinical, radiographic, esophageal manometric, and pathological findings in 10 patients with the acquired type of jejunal diverticulosis. Jejunoileal diverticulosis, a rare cause of ileal perforation. Based on our findings, we propose a hypothesis to explain the etiology and pathogenesis of this entity. Jejunal diverticulitis arises as a complication of diverticulosis.
We analyzed the clinical, radiographic, esophageal manometric, and pathological features of 10 patients referred with jejunal diverticulosis. Awareness of the wide spectrum of presentation and potential complications of small bowel diverticulosis can prevent delay in diagnosis. The ileal and jejunal diverticular disease is rare than diverticuli in duodenum and colon. Acute presentations of jejunal diverticula as acute. Related complications such as diverticulitis, perforation, bleeding or intestinal obstruction appear in 1030% of the patients increasing morbidity. Diverticulosis involves the large intestine more commonly than the small bowel, with reported incidence of small bowel diverticulosis being 0. Case contributed by dr wayland wang diagnosis almost certain diagnosis almost certain. Sep 15, 2012 nothing was done to the jejunal diverticula, as these were multiple and nonobstructive. Jejunal diverticula are uncommon and usually asymptomatic. There was a 5 x 4 cm size fecolith in distal jejunal loop causing obstruction, and an adhesion of sigmoid loop to one of the jejunal diverticula. Fourteen patients had complications that could be directly attributed to the presence of diverticula. Diverticulosis is rare in jejunum and its unusual presentation of mechanical obstruction is difficult to diagnose preoperatively. Jejunal diverticulitis is a rare clinical entity often overlooked by physicians as a cause for abdominal pain. Jejunal diverticulosis presenting as an acute emergency huma sabir khan and mahmood ayyaz abstract diverticulosis of jejunum is a relatively rare disease of bowel.
May, 2011 small bowel diverticulosis is an uncommon and often asymptomatic condition that is sporadically observed during radiographic examination or laparotomy. However, gastrointestinal barium studies and computed tomography ct of. The disease is usually asymptomatic and must be taken into consideration in cases of unexplained malabsorption, anemia, chronic abdominal pain or discomfort. Seven had surgery for mechanical obstruction, although none was found. Unlike colonic diverticulitis, nonsurgical treatment of jejunal diverticulitis is rarely effective.
Abdominal pain, diverticulitis, intestinal perforation. Clinical presentations were of acute abdomen, one of which initially thought to be a ruptured aneurysm. Acute presentations of this pathology are gastrointestinal bleeding, intraabdominal abscess, perforation with diffuse peritonitis, small bowel volvulus, and jejunocolic fistula. Jejunal diverticulitis is rare, but you likely will come across it with reasonable frequency in clinical practice. The majority of patients with jejunal diverticula have no symptoms. A case report s venkata reddy1, a b jagadeesh2, p sushma 2, k varun prakash, m mounika chowdary2 1associate professor, department of general surgery, rangaraya medical college, kakinada, andhra pradesh, india, 2postgraduate.
Thank you for your interest in spreading the word about the bmj. To best of our knowledge, only six cases were reported to have avms within jejunal diverticulosis 7,8,9,10,11,12. Multiple giant diverticula of the jejunum causing intestinal. Resection of diverticulae bearing jejunal loop and endtoend single layered anastomosis was performed. Jejunoileal diverticula, also referred to as jejunal diverticula or diverticulosis as most of the diverticula are located in the jejunum, are outpouchings from the jejunal and ileal wall on their mesenteric border that represent mucosal herniation through sites of wall weakening 1.
These are false diverticula occurring mainly in an older age group. Jejunal diverticulosis is one of todays hardtodiagnose disorders, despite the use of modern imaging techniques, due to its rare occurrence and the diversity of symptoms and physical examination. Giant and multiple jejunal diverticula presenting as peritonitis a. Massive gastrointestinal gi bleeding can occur with multiple jejunal diverticulosis. Diverticula can occur anywhere in the small intestine, but they are the most common in the jejunum. Approximately 15% of patients with jejunal diverticulosis may require small bowel resection for treatment of such complications. Jejunal diverticulosis in the elderly can lead to significant morbidity and mortality and so should be suspected in those presenting with crampy abdominal pain and altered bowel habits. The delay in diagnosis and in surgical management are the main poor prognostic factors. Complications were defined as those that presented with inflammation, bleeding, obstruction, or. There is a difference in quoted incidences of jejunal diverticulosis by radiological study and autopsy study.
Diagnosis is usually made incidentally or after complications. Complications were defined as those that presented with inflammation, bleeding, obstruction, or perforation. In the followup of 16 months, the patient was doing well. Jejunal pseudo diverticulosis is a rare acquired herniation of the mucosa and submucosa through weakened areas of the muscularis mucosa of. This report describes our experience of a case of jejunal diverticula perforation secondary to a large faecolith, with particular focus on the aetiology and management of this rare condition. Small intestinal diverticulosis clinical presentation. Massive rectal bleeding from acquired jejunal diverticula.
We report the successful surgical treatment of intestinal obstruction caused by enteroliths formed in jejunal diverticula. Jejunal diverticula are rare and are usually asymptomatic. A rare case of multiple jejunal diverticulosis presenting as. Complications of jejunal diverticulosis include perforation, acute intestinal obstruction and diverticular bleeding. Severe diverticulitis complications such as obstruction, hemorrhage, or perforation with a delayed diagnosis can. Among these small intestinal diverticula, duodenal divertic. Jejunal diverticulosis as the obscure cause of overt. Jejunoileal diverticulosis jid is a rare condition associated with nonspecific symptoms, consisting of acquired false diverticula. Jejunal diverticulitis is a rare entity with a higher prevalence among patients between 60 and 70 years. Jejunal diverticulosis presented with acute abdomen and. Scott, director of the general surgical residency program, york hospital. Multiple diverticulosis of jejunum represents an uncommon pathology of the small bowel.
Jejunal diverticulosis jd is a rare disease that has a variable presentation. Jejunal diverticulosis is an uncommon condition, but it is often associated with a number of symptoms including postprandial abdominal pain, distension, flatulence, borborygmus, nausea, vomiting, diarrhea and constipation and with complications such asncbi. Perforated jejunal diverticula secondary to a large faecolith. Multiple jejunal diverticula with jejunal volvulus. Open or laparoscopic resection of the involved small bowel segment and primary anastomosis is indicated for jejunoileal diverticulitis, bowel perforation or bleeding 23, 24. Complicated jejunal diverticulitis with unusual presentation. These manifest as diverticulitis, bleeding, perforation or intestinal.
Jejunal diverticula are usually found incidentally at laparotomy or during an upper gastrointestinal study the great majority remains asymptomatic. Emergency management of complicated jejunal diverticulosis. If these diverticula become acute inflamed, or even perforate or bleed, then symptoms usually manifest. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Furthermore, signs and symptoms of jejunal diverticulosis may vary on an individual basis for each patient. Diverticulosis of the jejunum and ileum are generally asymptomatic. Although diagnostic capabilities improved in recent years, there is little data about diverticular disease in the proximal small bowel. Case report midgut volvulus due to jejunal diverticula.
Very rarely, they can lead to acute complications such as bleeding, obstruction, and perforation. A triad of obscure pain, anemia and dilated jejunal loops was proposed to be the alarming symptoms of jejunal diverticulosis. There are very few case reports in the literature of jejunal diverticulosis presenting with perforation 6,7,9,10 our patient too remained asymptomatic, until he presented with acute abdomen because of perforated diverticuli. Symptomatic diverticular disease, defined as radiographic and hematologic confirmation of infection within the colon, should be treated initially with antibiotics and bowel rest. An abdominal xray displayed multiple dilated loops of the small bowel. Jejunoileal diverticula radiology reference article. Nine patients were over age 59 yr and had symptoms of intestinal pseudoobstruction of 543 yr duration. As jejunal diverticulitis is often asymptomatic, they commonly present with diagnostic dilemma. When a patient with multiple jejunal diverticula with jejunal volvulus is asymptomatic, ct and angiography can be helpful for its accurate and immediate diagnosis. Jejunal diverticulosis complicated with perforation. This program and community of women has been the single most. However, only six cases reported the arteriovenous malformations within jejunal diverticulosis to be the cause of hemorrhage. The aetiology of jejunal diverticulosis is unclear. The majority of cases of jejunal diverticulosis have been noted in patients in their sixth and seventh decades of life.
Once diagnosed, conservative medical management should be instituted to alleviate symptoms and reduce the risk of complications. Nonsurgical management of acute jejunal diverticulitis. When symptomatic, they present with chronic nonspecific symptoms like pain, nausea, malnutrition and sometimes with acute presentation like gastrointestinal hemorrhage, peritonitis and obstruction. Jejunal diverticulosis with perforation a challenging. This article describes three cases of jejunal diverticulitis in elderly women, who had presented with pain and tenderness in the periumbilical region or the left side of the abdomen, lowgrade fever, anemia, and weight loss. Jejunoileal diverticulosis is a rare condition that continues to present formidable challenges in diagnosis and treatment. Giant and multiple jejunal diverticula presenting as. Small bowel contrast studies showed the incidence of. Even the most published literature on jejunum and ileal diverticular disease stated of pseudodiverticuli than true diverticuli 4, 5. Jejunal diverticula are rare and usually occur in the elderly. It frequently coexists with colonic diverticulosis. We present a case of arteriovenous malformations within jejunal diverticulosis in a 68yearold male presented with lower gastrointestinal bleeding. Diverticular disease dr doha rasheedy ali assistant. This signs and symptoms information for jejunal diverticulosis has been gathered from various sources, may not be fully accurate, and may not be the full list of jejunal diverticulosis signs or jejunal diverticulosis symptoms.
Nomenclature diverticulum saclike protrusion of the gut wall diverticulosis describes the presence of diverticuli diverticulitis inflammation of diverticuli 3. The prevalence of small intestinal diverticula on autopsy ranges from 0. We use cookies to make interactions with our website easy and meaningful, to better understand the use of our services, and to tailor advertising. Its preoperative diagnosis is difficult, but should be considered in cases of unexplained abdominal symptoms and peritonitis. Jejunoileal diverticulosis and its associated complications are rare. They concluded that it is a major clinical presentation of jejunal diverticulosis. These include hemorrhage, obstruction and diverticulitis, with or without perforation. A case report jiali hu, weizhong chen world j gastroenterol 2012 october 28. We present three cases, in which a laparotomy was performed twice and one in which conservative treatment was applied. Jejunal diverticulosis is a rare intestinal pathology with an incidence of 0. Diverticulosis of jejunum a rare cause of acute abdomen.
In a group of 62 patients with jejunal diverticulosis seen at the cincinnati general. Exploratory laparotomy was performed and confirmed an intraluminal jejunal enterolith and jejunal diverticulosis. Unlike colonic diverticulitis, conservative management involving bowel rest and antibiotic administration is rarely successful. Acute presentations of jejunal diverticula as acute abdomen a case series. Nowadays the mortality was reduced because of the improvement of the diagnostic, pharmaceutical and surgical protocols, but preoperative diagnosis of jejunal diverticulitis is still rarely made. The jejunum is a more common site of acquired diverticula of the small bowel than the ileum 1. A 78yearold man with bowel obstruction of unknown etiology was initially managed conservatively, but suffered recurrence of the obstruction. Jejunal diverticulosis presenting as an acute emergency. Colonic diverticula have a high association with the presence of jejunal diverticula 9. Enterolith smallbowel obstruction caused by jejunal. Peritonitis caused by perforated jejunal diverticula can be localized and selflimiting, because most of the diverticula are at the mesenteric border of the bowel and readily allow the small bowel mesentery to seal them off. Jejunal diverticulosis is a sporadic seen disease which was generally asymptomatic.
Jejunal diverticulosis found in a patient with long. The findings were initially attributed to possible inflammatory or neoplastic lesions of the colon. The clinician should suspect small bowel diverticulosis if there is a history of colonic diverticula. Maglinte et al described an incidence of small bowel diverticular disease of. Small bowel diverticulitis is rare and there are no known guidelines for treatment. Small bowel diverticulitis as a cause of acute abdomen. Acute complications occur in 10%20% of patients with jejunal diverticular disease and include intestinal hemorrhage, diverticulitis with or without perforation and obstruction. The surgical significance of jejunal diverticulosis jama. Jejunal diverticulitis results in abdominal pain and fever, and can be complicated by localized perforation and abscess formation.