Jejunal diverticulitis is a rare clinical entity often overlooked by physicians as a cause for abdominal pain. Diverticulosis of jejunum a rare cause of acute abdomen. Jejunal diverticulosis presented with acute abdomen and. We analyzed the clinical, radiographic, esophageal manometric, and pathological features of 10 patients referred with jejunal diverticulosis. Related complications such as diverticulitis, perforation, bleeding or intestinal obstruction appear in 1030% of the patients increasing. Jejunal diverticulosis presenting as an acute emergency. May 25, 2007 surgical management of small bowel diverticulosis was first described in 1906 by gordinier and sampson. Among these small intestinal diverticula, duodenal divertic. Diverticulosis and diverticular disease slideshare. Seven had surgery for mechanical obstruction, although none was found. Small bowel diverticulitis as a cause of acute abdomen. Nov 03, 2010 jejunoileal diverticulosis and its associated complications are rare.
Arteriovenous malformations within jejunal diverticulosis. The majority of patients with jejunal diverticula have no symptoms. Thank you for your interest in spreading the word about the bmj. There is a difference in quoted incidences of jejunal diverticulosis by radiological study and autopsy study. Jejunal diverticulosis is a rare condition with variable clinical and anatomical presentations. Giant and multiple jejunal diverticula presenting as.
It may lead to symptoms presenting with an acute onset or to chronic and nonspecific complaints. Small bowel diverticulitis is rare and there are no known guidelines for treatment. 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. These manifest as diverticulitis, bleeding, perforation or intestinal. Jejunal diverticular perforation with intraabdominal abscess. Jejunoileal diverticulosis and its associated complications are rare.
The literature estimates that jejunal diverticulosis has an incidence of 0. May, 2011 small bowel diverticulosis is an uncommon and often asymptomatic condition that is sporadically observed during radiographic examination or laparotomy. Ct scan can be helpful in diagnosis of jejunal diverticula. Open or laparoscopic resection of the involved small bowel segment and primary anastomosis is indicated for jejunoileal diverticulitis, bowel perforation or bleeding 23, 24. We report the case of an 82yearold caucasian woman presenting with a oneday history of generalized abdominal pain, with three episodes of vomiting. Multiple diverticulosis of jejunum represents an uncommon pathology of the small bowel. Jejunal diverticulosis with perforation a challenging. The disease is usually asymptomatic and must be taken into consideration in cases of unexplained malabsorption, anemia, chronic abdominal pain or discomfort.
Given the high mortality rate of jejunal diverticulitis, a precise diagnosis followed by appropriate therapeutic intervention is essential. Its preoperative diagnosis is difficult, but should be considered in cases of unexplained abdominal symptoms and peritonitis. In summary, we present a case of multiple jejunal diverticula with jejunal volvulus. Jejunal diverticulosis as the obscure cause of overt. We hereby report a 52 year old male with perforated jejunal diverticula. Jejunal diverticulosis presenting as an acute emergency huma sabir khan and mahmood ayyaz abstract diverticulosis of jejunum is a relatively rare disease of bowel. Jejunal diverticular perforation causing small bowel. 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. There is a thickened loop of jejunum with moderate degree of fat stranding affecting the associated mesentery. The prevalence of small intestinal diverticula on autopsy ranges from 0.
While most cases are asymptomatic, 3040% of the cases may become symptomatic with chronic abdominal pain, malabsorption, hemorrhage, diverticulitis, obstruction. Abdominal pain, diverticulitis, intestinal perforation. Complications of jejunal diverticulosis include perforation, acute intestinal obstruction and diverticular bleeding. Jejunoileal diverticulosis is a rare condition that continues to present formidable challenges in diagnosis and treatment. To best of our knowledge, only six cases were reported to have avms within jejunal diverticulosis 7,8,9,10,11,12. Jejunal diverticula are usually found incidentally at laparotomy or during an upper gastrointestinal study the great majority remains asymptomatic. However, they can present with a number of acute and emergent complications with a high. Jejunal diverticulosis with enterolith presenting as acute. Other modalities of diagnosing jejunal diverticula include wireless capsule endoscopy and small bowel. Even the most published literature on jejunum and ileal diverticular disease stated of pseudodiverticuli than true diverticuli 4, 5.
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. Jejunal diverticulosis found in a patient with long. However, only six cases reported the arteriovenous malformations within jejunal diverticulosis to be the cause of hemorrhage. Massive rectal bleeding from acquired jejunal diverticula. The aetiology of jejunal diverticulosis is unclear. 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. The aim of this study is to present the clinical course. The ileal and jejunal diverticular disease is rare than diverticuli in duodenum and colon.
However, significant bleeding in the setting of few diverticulae is very unusual and rare. Jejunal diverticulosis is a sporadic seen disease which was generally asymptomatic. The surgical significance of jejunal diverticulosis jama. This program and community of women has been the single most. 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 diverticular disease complicated by enteroliths. Jejunal diverticulosis is usually asymptomatic, and uncomplicated jejunal diverticulosis does not need any surgical intervention. Small intestinal diverticula are far less common than colonic diverticula.
Surgical resection should be as limited as possible in case of extensive jejunal diverticulosis, to avoid short bowel syndrome. This report defines the clinical, radiographic, esophageal manometric, and pathological findings in 10 patients with the acquired type of jejunal diverticulosis. Massive gastrointestinal gi bleeding can occur with multiple jejunal diverticulosis. 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. We present a case of arteriovenous malformations within jejunal diverticulosis in a 68yearold male presented with lower gastrointestinal bleeding. 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. 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. Diverticulosis involves the large intestine more commonly than the small bowel, with reported incidence of small bowel diverticulosis being 0. Complicated smallbowel diverticulosis is a rather uncommon cause of upper abdominal pain. 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. The cause of inflammation is the same as colonic diverticulitis, and thus treatment is basically the same.
Although it is frequently seen in duodenum, jejunal and ileal locations are very rare. Jejunal diverticulosis complicated with perforation. Once diagnosed, conservative medical management should be instituted to alleviate symptoms and reduce the risk of complications. 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. Multiple jejunal diverticula with jejunal volvulus. 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. Clinical presentation is characterized with pain in the upper left quadrant of the. The typical presentation of jejunal diverticula is intermittent. Diverticulosis of the jejunum is a rare condition with an incidence ranging from 0. Jejunal diverticula are rare and are usually asymptomatic.
The disorder seems to be mostly acquired, but two families with extensive jejunal diverticulosis have been published in 1988 and 2007 1, 2. Acute presentations of jejunal diverticula as acute abdomen a case series. Very rarely, they can lead to acute complications such as bleeding, obstruction, and perforation. Jejunoileal diverticula radiology reference article. 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.
Jejunal diverticula are an uncommon acquired disease that is usually silent and asymptomatic. Perforation of jejunal diverticulum is quite uncommon. She is still on hemodialysis program with routine control visits to the nephrology. As jejunal diverticulitis is often asymptomatic, they commonly present with diagnostic dilemma. 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. Duodenal and meckel diverticulum excluded, small bowel diverticula are most common in the proximal jejunum. Diverticular disease dr doha rasheedy ali assistant. 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.
Nonsurgical management of acute jejunal diverticulitis. Acute complications occur in 10%20% of patients with jejunal diverticular disease and include intestinal hemorrhage, diverticulitis with or without perforation and obstruction. Jejunal diverticulosis jd is a rare disease that has a variable presentation. Small bowel contrast studies showed the incidence of. 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. We report the successful surgical treatment of intestinal obstruction caused by enteroliths formed in jejunal diverticula. In a group of 62 patients with jejunal diverticulosis seen at the cincinnati general. Although there is no consensus on the management of asymptomatic jejunal diverticular disease, some complications are potentially life threatening and require early surgical treatment. 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. If these diverticula become acute inflamed, or even perforate or bleed, then symptoms usually manifest. If you continue browsing the site, you agree to the use of cookies on this website.
Jejunoileal diverticulosis, a rare cause of ileal perforation case report. Surgical treatment of giant small bowel diverticula with acute. Unlike colonic diverticulitis, nonsurgical treatment of jejunal diverticulitis is rarely effective. Diverticulosis of the jejunum and ileum are generally asymptomatic. Nomenclature diverticulum saclike protrusion of the gut wall diverticulosis describes the presence of diverticuli diverticulitis inflammation of diverticuli 3. The prevalence of the disorder on autopsy ranges 0. A 78yearold man with bowel obstruction of unknown etiology was initially managed conservatively, but suffered recurrence of the obstruction. Exploratory laparotomy was performed and confirmed an intraluminal jejunal enterolith and jejunal diverticulosis.
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 diverticula are rare and usually occur in the elderly. As the presentation is often similar to other pathologies acute. Case report midgut volvulus due to jejunal diverticula. These include hemorrhage, obstruction and diverticulitis, with or without perforation. 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. Symptomatic diverticular disease, defined as radiographic and hematologic confirmation of infection within the colon, should be treated initially with antibiotics and bowel rest. Unlike colonic diverticulitis, conservative management involving bowel rest and antibiotic administration is rarely successful. Jejunal diverticula are false diverticula with projections of mucosa and serosa without the muscular layer. Jejunal diverticulitis is rare, but you likely will come across it with reasonable frequency in clinical practice. Perforated jejunal diverticula secondary to a large faecolith. We present three cases, in which a laparotomy was performed twice and one in which conservative treatment was applied. 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.
Emergency management of complicated jejunal diverticulosis. Jejunal diverticulitis results in abdominal pain and fever, and can be complicated by localized perforation and abscess formation. Jejunal diverticulosis is a rare entity with a reported clinical incidence of 0. Complicated jejunal diverticulitis with unusual presentation. Jejunal pseudo diverticulosis is a rare acquired herniation of the mucosa and submucosa through weakened areas of the muscularis mucosa of. We report a case of perforated jejunal diverticulum presented with a 6month history of significant weight loss and acute abdominal pain. However, gastrointestinal barium studies and computed tomography ct of. Based on our findings, we propose a hypothesis to explain the etiology and pathogenesis of this entity. Perforation of jejunal diverticulum is difficult to diagnose due to localized peritonitis and requires urgent surgical intervention. Complications were defined as those that presented with inflammation, bleeding, obstruction, or. In the small bowel, duodenum is the most common site of diverticulosis followed by the jejunum and the ileum.
A triad of obscure pain, anemia and dilated jejunal loops was proposed to be the alarming symptoms of jejunal diverticulosis. Jejunal diverticulosis is a rare intestinal pathology with an incidence of 0. However, they may cause chronic nonspecific symptoms or rarely lead to an acute presentation. Diverticula can occur anywhere in the small intestine, but they are the most common in the jejunum. The jejunum is a more common site of acquired diverticula of the small bowel than the ileum 1. The authors report a case of jejunal diverticulitis that was initially treated with medical management but eventually required surgical intervention. Jejunoileal diverticulosis, a rare cause of ileal perforation. Colonic diverticula have a high association with the presence of jejunal diverticula 9.
The findings were initially attributed to possible inflammatory or neoplastic lesions of the colon. The majority of cases of jejunal diverticulosis have been noted in patients in their sixth and seventh decades of life. Acute presentations of jejunal diverticula as acute. Jejunal diverticulitis is a rare entity with a higher prevalence among patients between 60 and 70 years.
Small intestinal diverticulosis clinical presentation. It frequently coexists with colonic diverticulosis. Jejunal diverticulitis arises as a complication of diverticulosis. 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. We use cookies to make interactions with our website easy and meaningful, to better understand the use of our services, and to tailor advertising. A case report jiali hu, weizhong chen world j gastroenterol 2012 october 28. Jejunal diverticula are uncommon and usually asymptomatic. Awareness of the wide spectrum of presentation and potential complications of small bowel diverticulosis can prevent delay in diagnosis. Resection of diverticulae bearing jejunal loop and endtoend single layered anastomosis was performed.
Scott, director of the general surgical residency program, york hospital. These are false diverticula occurring mainly in an older age group. A rare case of multiple jejunal diverticulosis presenting as. 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. The clinician should suspect small bowel diverticulosis if there is a history of colonic diverticula. Case contributed by dr wayland wang diagnosis almost certain diagnosis almost certain. Case report open access massive rectal bleeding from. The clinical presentation of diverticulosis depends on. Jejunoileal diverticulitis radiology reference article. Resection of involved gut with end to end jejuno jejunal anastomosis was done. Asymptomatic diverticular disease is best managed by fiberenriched diet 30 g of fiberd avoid nuts and popcorn. Jejunal diverticular perforation with intraabdominal. Jejunal perforation with intraabdominal abscess formation of jejunal diverticula is a rare complication.
Furthermore, signs and symptoms of jejunal diverticulosis may vary on an individual basis for each patient. Diagnosis is usually made incidentally or after complications. Acute presentations of this pathology are gastrointestinal bleeding, intraabdominal abscess, perforation with diffuse peritonitis, small bowel volvulus, and jejunocolic fistula. Multiple giant diverticula of the jejunum causing intestinal. When symptomatic, they present with chronic nonspecific symptoms like pain, nausea, malnutrition and sometimes with acute presentation like gastrointestinal hemorrhage, peritonitis and obstruction. They concluded that it is a major clinical presentation of jejunal diverticulosis. Giant and multiple jejunal diverticula presenting as peritonitis a. Perforated jejunal diverticulitis fulltext case reports in. Sep 15, 2012 nothing was done to the jejunal diverticula, as these were multiple and nonobstructive. Herewith, we are presenting a very rare case of jejunal diverticulosis with complication, noted at a tertiary care hospital in southern india.
Although diagnostic capabilities improved in recent years, there is little data about diverticular disease in the proximal small bowel. Nine patients were over age 59 yr and had symptoms of intestinal pseudoobstruction of 543 yr duration. Complications were defined as those that presented with inflammation, bleeding, obstruction, or perforation. Approximately 15% of patients with jejunal diverticulosis may require small bowel resection for treatment of such complications. 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. Related complications such as diverticulitis, perforation, bleeding or intestinal obstruction appear in 1030% of the patients increasing morbidity. In the followup of 16 months, the patient was doing well. Enterolith smallbowel obstruction caused by jejunal.
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. The occurrence of complicated diverticular disease is common among the elderly. The delay in diagnosis and in surgical management are the main poor prognostic factors. Jejunoileal diverticulosis jid is a rare condition associated with nonspecific symptoms, consisting of acquired false diverticula.
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