Jejunal diverticulae: reports of two cases with review of literature

Singh, Onkar; Gupta, Shilpi Singh; Shukla, Sudhish Kumar; Mathur, Rajkumar; Shukla, Satish

doi:10.1007/s12262-009-0077-5

Cited by 18 publications

(31 citation statements)

References 35 publications

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“…in India, We have found seven cases of jejunal diverticulosis reported in India, five of them presented with complications like perforation, gastrointestinal bleeding and intestinal obstruction [3,[5][6][7][8][9][10]. In this regard, a recent cadaveric study of duodenum conducted in South India showed the prevalence of 4.2% for duodenal diverticulosis [11].…”

Section: Resultsmentioning

confidence: 99%

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Jejunal Diverticulosis with Perforation – A Challenging Differential Diagnosis of Acute Abdomen: Case Report

NatarajaN

Phansalkar

Varghese

et al. 2015

JCDR

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A 56-year-old male presented with dragging upper abdominal pain of one week duration. There was a history of dyspepsia, abdominal discomfort and vomiting after meals for past one week and low grade fever associated with chills and rigors.On examination, the patient was febrile with a temperature of 99 0 F, pulse rate -110/min, blood pressure -130/90 mm Hg. Abdominal examination revealed generalized tenderness with fullness over the right hypochondrium.Laboratory work up revealed Hb-13g/dl, TLC-10,000/cu.mm, DLC -P90 L7 E1 M2, urea -49mg/dl, creatinine -0.5mg/dl. Abdominal radiograph revealed air under the diaphragm. Abdominal CT scan and ultrasound showed multiple diverticuli in the small intestine [Table/ Fig-1] and air under the diaphragm suggesting perforation.Emergency midline laparotomy was performed. Intra-operatively multiple jejunal diverticuli were found on the mesenteric border. They were located between 8 cm to 20 cm from duodeno-jejunal (DJ) flexure. Serosal purulent exudates and multiple inter-loop adhesions were noted. There was purulent material in the peritoneum as well. Proximal jejunal resection with end to end anastomosis was done. The post operative period was uneventful and the patient was discharged on 10 th day after the surgery. One month follow up was uneventful.Gross examination of resected specimen revealed a segment of small bowel, 65 cm in length with eight outpouchings on the serosal aspect along the mesenteric border, of which largest measured 4x3x1 cm with focal areas of exudates on the serosal aspect and adhesions; smallest measured 2x1.5x0.5cm [Table/ Fig-2]. Three ABStRACtMultiple diverticulosis of the jejunum represents a very rare entity. Jejunal diverticula are found to be the rarest of all small bowel diverticula. The disease is usually asymptomatic and often becomes clinically relevant when complicated. This rarity makes it a difficult differential diagnosis. Related complications such as diverticulitis, perforation, and bleeding and/or intestinal obstruction appear in about 10-30% of the patients which increase the morbidity and mortality rates in such individuals. Here, we present a case of jejunal diverticulosis with perforation who presented with symptoms of acute abdominal pain, vomiting and fever along with a brief review of literature.

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Section: Resultsmentioning

confidence: 99%

“…Investigation modalities like CT scan, single or double balloon enteroscopy are useful in diagnosing small bowel disorders [15]. But, they are expensive and cannot be used in an emergency setting [3,5,6]. However, abdominal and chest X-rays can demonstrate perforation.…”

Section: Resultsmentioning

confidence: 99%

Jejunal Diverticulosis with Perforation – A Challenging Differential Diagnosis of Acute Abdomen: Case Report

NatarajaN

Phansalkar

Varghese

et al. 2015

JCDR

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“…The surgical findings were matching the radiological report of an uncomplicated diverticulitis without signs of the above mentioned main complications. Thus a thorough abdominal lavage and the insertion of abdominal drains were the only procedures carried out by the surgeons.This approach seemed appropriate to us and is supported by other cases of local and self-limited inflammation [2,[7][8][9].…”

Section: Introductionmentioning

confidence: 83%

Jejunal Diverticulitis Ascending to the Duodenum as a Rare Cause of Acute Abdomen

Vieweg¹

2014

JCDR

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A 73 year-old man was admitted to our hospital with complaints of sudden onset of abdominal pain, nausea and vomiting. The pain was localized mainly in the upper left abdomen with clinical signs of peritonitis. During the time in the emergency department, the abdominal pain markedly worsened. On examination by the attending emergency physician, he responded adequately and was fully oriented. Blood pressure was 120/70 mm Hg, pulse was 110 beats per minute, body temperature was 36.9°C, respiratory rate was 18, and oxygen saturation was 97% with 4 liter oxygen via nasal cannula. The abdomen was rigid, with distension mainly in the upper left abdomen. Normal saline and morphine sulfate were administered intravenously. Blood levels of gamma-gt (102 U/l), lactatdehydrogenase (367 U/l), bilirubin (2.2 mg/dl), direct bilirubin (0.59 mg/dl), serum glucose (259 mg/dl), lactate (2.9 mmol/l) and leukocytes (32.000) were markedly elevated. The patient's medical history revealed coronary heart disease, insulin-dependent diabetes mellitus, hypertension, Barrett oesophagus, hiatus hernia, a post appendectomy status and a history of stroke. He had a smoking history of 20 pack-years, and occasional consumption of alcohol. The use of illicit drugs was denied, and he didn´t remember unusual ingestions.A plain radiograph of the abdomen showed no evidence of free abdominal air, air-fluid levels or dilated intestinal loops.Abdominal ultrasonography revealed thickened walls of small bowel loops with cockade signs and moderate ascites.By reason of a lack of clear diagnosis and severe abdominal pain despite intravenously administered morphine, a CT-angiography of the abdomen was resolved.The scans revealed thickened walls of the small bowel over a distance of approximately 16 cm, extending from the distal second part of the duodenum to the proximal jejunum. There were moderate amounts of perihepatic and perisplenic fluid. No free intraperitoneal air was found. The mesenteric vasculature was unremarkable. Multiple fluid filled diverticula measuring up to 3 cm in the longest diameter were found alongside the jejunal walls. Additionally there was surrounding fat stranding from the distal second part of the duodenum to the proximal jejunum [Table/ Fig-1,2].The findings were indicative of an exacerbation of chronic jejunal diverticulitis with acute diverticulitis of the proximal jejunum, Radiology section ascending to the duodenum. Conservative antibiotic therapy was initiated but due to increasing pain in the night, an exploratory laparotomy was carried out on the next morning. Upon exploration 3 inflamed jejunal diverticula were detected in the area of the ligament of Treitz accompanied by moderate amounts of brownish non-foul smelling fluid and paralytic jejunal loops. The walls from the distal second part of the duodenum to the proximal jejunum appeared congested and inflamed. However, there were no signs of bowel ischemia, covered or open perforation. Four abdominal drains were inserted intraoperatively. The patient's postoperative cours...

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“…It is contraindicated in case of perforation or acute diverticulitis to suggest a perforation. [8] Endoscopic procedures, such as double-ballon endoscopy and capsule endoscopy may be helpful in the diagnosis of small bowel diverticula, but have limited utility in emergency setting. Diagnostic laparoscopy is a valuable method and may sometimes prevent unnecessary laparotomies.…”

Section: Case Reportmentioning

confidence: 99%