Small Bowel Diverticulosis: Pathogenesis, Clinical Management, and New Concepts

Rangan, V. Kasturi; LaMont, J. Thomas

doi:10.1007/s11894-019-0741-2

Cited by 41 publications

(63 citation statements)

References 35 publications

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“…The first-line treatment against jejunoileal diverticulitis with localized perforations is controversial. Rangan [ 12 ] reports that nonoperative management, including antibiotics and percutaneous drainage, can be considered. However, some conservative treatment reportedly has failed for exacerbation, and surgery was finally performed [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Whole jejunoileal diverticulosis with recurrent inflammation and perforation: A case report

Watanabe

Murata

Hirota

et al. 2021

International Journal of Surgery Case Reports

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Introduction Jejunoileal diverticulitis is uncommon and poorly understood. We report a case of whole jejunoileal diverticulosis with recurrent inflammation and perforation. Case presentation A 72-year-old man with hemodialysis presented with fever and abdominal pain. The patient had a medical history of twice having jejunoileal diverticulitis. Serum testing indicated a white blood cell count of 15,670/μL and a C-reactive protein level of 10.31 mg/dL. Contrast-enhanced computed tomography showed jejunoileal diverticulosis with the concomitant mesenteric fat opacity and a 60-mm × 45-mm mass lesion containing extraluminal air bubbles. Jejunoileal partial resection was performed. Multiple diverticulosis was recognized over the entire jejunoileum, and the pouches existed along entry points of the bowel vascular supply through the mesentery. Intestinal resection was limited to the intestinal loop associated with complicated diverticulitis with abscess. Macroscopic examination revealed multiple jejunoileal diverticulosis. In the reddened mucosa, the diverticulitis and mesenteric perforation were recognized. Microscopic examination showed protrusion of mucosal and submucosal layers through a defect in the muscular layer with gangrenous inflammation. These findings supported a diagnosis of jejunoileal diverticulitis with perforation and abscess. The patient had no postoperative complications and no recurrence within 6 months. Discussion Treatment for jejunoileal diverticulitis should be individualized for each patient according to their degree of inflammation, recurrence, and the patient's background. Conclusion Extensive diverticulosis over the entire jejunoileum is very rare. In this case, the section of the inflamed diverticulosis can be distinguished and resected to avoid a short-bowel syndrome, which should lead to an uneventful postoperative course.

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Section: Discussionmentioning

confidence: 99%

Whole jejunoileal diverticulosis with recurrent inflammation and perforation: A case report

Watanabe

Murata

Hirota

et al. 2021

International Journal of Surgery Case Reports

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“… 10 Findings of SBD involve the presence of rounded duodenal or jejunoileal outpouchings, which can contain air, simple fluid, or enteric contrast. 5 Oftentimes, they have a barely discernable, smooth wall and are seen in profile.…”

Section: Discussionmentioning

confidence: 99%

“…Asymmetric wall thickening adjacent to a diverticulum associated with peridiverticular mesenteric fat stranding is characteristic of acute diverticulitis. 5 …”

Section: Discussionmentioning

confidence: 99%

Perforated Jejunal Diverticulitis: a rare cause of acute abdominal pain

Ismail

Chaabene

Rebii

et al. 2021

Clinical Case Reports

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“…Most small bowel diverticula are asymptomatic, with an estimated 4% to 10% of patients presenting with chronic nausea, bloating, flatulence, and diarrhea [ 4 , 9 ]. While diverticulitis is the most common complication reported for jejunal diverticulosis, other complications include hemorrhage, perforation, obstruction, and volvulus [ 2 , 4 , 10 , 11 ]. Asymptomatic small bowel diverticulosis can be observed; however, once it is symptomatic, operative treatment is usually required.…”

Section: Discussionmentioning

confidence: 99%

Eosinophilic Gastroenteritis Causing Small Bowel Diverticulosis and Volvulus: A Case Report

2021

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Patient: Female, 83-year-old Final Diagnosis: Eosinophilic gastroentritis • jejunal diverticulosis Symptoms: Abdominal pain • obstruction Medication: — Clinical Procedure: — Specialty: Surgery Objective: Rare coexistence of disease or pathology Background: Eosinophilic gastroenteritis is a broad classification of disease characterized by eosinophilic infiltration of the gastrointestinal tract in the absence of a stimulatory cause. Given the ability of eosinophilic gastroenteritis to affect the entire gastrointestinal tract, it can present in a variety of ways, from chronic intermittent pain to mechanical obstruction. We present a rare case in which eosinophilic gastroenteritis of the jejunum led to small bowel diverticulosis and volvulus, requiring surgery. Case Report: An 83-year-old woman with a history of chronic abdominal pain, nausea, and early satiety presented to our clinic after a thorough gastrointestinal workup and radiologic diagnosis of partial midgut volvulus. She underwent an exploratory laparotomy and was found to have normal rotational anatomy with prominent small bowel diverticulosis. A section of 70 cm of proximal jejunum was resected, encompassing all visible diverticula, and a primary anastomosis was performed. The patient recovered without complication. She was seen at follow-up with complete resolution of her presenting symptoms. Conclusions: We propose that this patient’s pathology was caused by chronic intermittent obstructions related to eosinophilic gastroenteritis, leading to repeated periods of increased intraluminal pressure and severe small bowel diverticulosis. This case highlights the importance of maintaining an index of suspicion for small bowel diver-ticulosis in the setting of chronic eosinophilic gastroenteritis.

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Small Bowel Diverticulosis: Pathogenesis, Clinical Management, and New Concepts

Cited by 41 publications

References 35 publications

Whole jejunoileal diverticulosis with recurrent inflammation and perforation: A case report

Whole jejunoileal diverticulosis with recurrent inflammation and perforation: A case report

Perforated Jejunal Diverticulitis: a rare cause of acute abdominal pain

Eosinophilic Gastroenteritis Causing Small Bowel Diverticulosis and Volvulus: A Case Report

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