Perforated midgut diverticulitis: Revisited

Abstract

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

Diverticulitis aguda de intestino delgado en un paciente con enfermedad de Crohn: Report of one case

“…Respecto a la diverticulitis yeyunal sintomática, existen escasos reportes en la literatura, con recomendaciones basadas principalmente en la experiencia de los autores. De manera similar a lo que ocurre en la diverticulitis de colon, el tratamiento no quirúrgico sería la elección en pacientes con diverticulitis de yeyuno sin perforación libre 17 con resultados satisfactorios 22 . En pacientes con evidencias de perforación libre, peritonitis difusa o inestabilidad clínica el tratamiento de elección es la cirugía 5 .…”

“…Hay que considerar que han sido descritas complicaciones postquirúrgi-cas, incluyendo mortalidad 24,25 . Considerando este punto, el lavado por laparoscopia con instalación de drenaje asociado a un tratamiento conservador ha sido sugerido en pacientes sin evidencias de peritonitis generalizada 22 . Es el contexto de la gravedad global extrema del paciente con requerimientos elevados de drogas vasoactivas, apoyo con ventilación mecánica y diálisis asociado a una comorbilidad como es la EC, las que pesaron al momento de optar por un manejo conservador con antibióticos y apoyo intensivo.…”

Perforated jejunal diverticulum: a rare presentation of acute abdomen

“…There is some evidence to support lavage and drainage in the setting of contained micro perforation followed by a continuation of conservative management. This however is to be reserved a means to avoid small bowel resection in high-risk patient groups 13 14…”

“…While there is emerging evidence for the role of conservative management in the case of microperforation13 14 the concern for progression to free perforation, especially in the setting of large lesions, makes segmental resection the preferred intervention.

Learning points

Jejunal diverticulosis is a rare clinical entity; however, its true incidence may be masked by the non-specific manner in which it typically presents.

The rate of serious complications requiring operative management, such as bleeding and perforation, can be upwards of 15%.

Conventional diagnostic modalities are not specific for this process, and options are further limited in the setting of an acute abdomen.

…”

Role of robotic approach for management of complicated jejunoileal diverticulosis – a video vignette

“…Surgery is the definitive treatment for JID and can be considered to improve the patient's quality of life and to prevent further occurrence of severe symptoms . A minimally invasive approach facilitates postoperative recovery, lowers risks and improves outcomes in JID treatment . Robotic surgery has revolutionized the minimally invasive approach with improvements in vision, ergonomics and precision of dissection.…”