Perforated jejunal diverticula: a case report. J Med Case Rep 4:172

Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland. .
Journal of Medical Case Reports 06/2010; 4(1):172. DOI: 10.1186/1752-1947-4-172
Source: PubMed


Jejunal diverticula are rare and are usually asymptomatic. However, they may cause chronic non-specific symptoms or rarely lead to an acute presentation.
We report the case of an 82-year-old Caucasian woman presenting with a one-day history of generalized abdominal pain, with three episodes of vomiting. An abdominal X-ray displayed multiple dilated loops of the small bowel. A subsequent computed tomography scan of the abdomen and pelvis revealed a thickening of the duodenum and dilatation of the proximal jejunum. Multiple small bowel diverticula were identified with surrounding pockets of free air adjacent to the jejunal diverticula suggestive of a small bowel perforation. Our patient underwent a laparotomy, which identified multiple jejunal diverticula with two pinhole jejunal perforations and associated fecal contamination. The perforations were repaired with primary closure and extensive washout was performed.
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.

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Available from: Chris Collins, May 20, 2014
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    • "These include chronic abdominal pain, malabsorption syndrome, hemorrhage, diverticulitis, Intestinal Obstruction (as in index case), abcess formation,and rarely, perforation as reported by Butler et al. [5]. Complications of jejunal Fig. 4. Section from area of haustration ( "
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    ABSTRACT: Diverticular disease is uncommon among Africans though increasing number of cases is now being reported, mainly of colonic diverticulosis. This condition afflicts all parts of the gastrointestinal tract but commonly the colon. Jejunal diverticula are rare, usually asymptomatic but may lead to an acute abdomen. A 68 year old female trader, who was referred from a peripheral center with insidious onset of severe colicky, generalized abdominal pain, repeated vomiting of recently ingested meal, no hematemesis. There was constipation and abdominal distension. The working diagnosis was dynamic intestinal obstruction of small bowel origin. She had emergency exploratory laparotomy following resuscitation. The findings were: volvulus of the jejunum and multiple jejunal diverticula. A resection of 80cm of the jejunum with most of the diverticula involved in the torsion was done with an end-to-end anastomosis of the jejunum. Her out-patient follow-up has been uneventful. Jejunal diverticular disease is rare in Africa. Our patient presented with small bowel obstruction due to volvulus. Other complications are discussed. Intestinal obstruction from diverticular disease is not always of colonic origin. It can occur in the jejunum. Copyright © 2015 Z. Published by Elsevier Ltd.. All rights reserved.
    International Journal of Surgery Case Reports 02/2015; 17. DOI:10.1016/j.ijscr.2015.02.017
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    • "Some patients have a history of chronic symptoms such as vague abdominal discomfort, fullness, pain or recurrent central and upper abdominal cramps because of pseudo-obstruction. Anemia due to iron deficiency and megaloblastic anemia have often been reported and commonly attributed to malabsorption, steatorrhea, and B12 vitamin deficiency [3]. Patients with JD can present with emergent complications such as massive gastrointestinal bleeding, intestinal obstruction or perforation [15]. "
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    ABSTRACT: Jejunal diverticulosis is an uncommon disease and usually asymptomatic. It can be complicated not only by diverticulitis, but by hemorrhage, perforation, intussusception, volvulus, malabsorption and even small bowel obstruction due to enteroliths formed and expelled from these diverticula. We describe a case of an occult bleeding jejunal diverticulum, casually discovered in a patient that was taken to surgery for a Dieulafoy's lesion after unsuccessful endoscopic treatment. We performed a gastric resection together with an ileocecal resection.Macroscopic and microscopic examinations confirmed the gastric Dieulafoy's lesion and demonstrated the presence of another source of occult bleeding in asymptomatic jejunal diverticulum. The current case emphasizes that some gastrointestinal bleeding lesions, although rare, can be multiple and result in potentially life-threatening bleeding. The clinician must be mindful to the possibility of multisite lesions and to the correlation between results of the investigations and clinical condition of the bleeding patient.
    BMC Surgery 11/2012; 12 Suppl 1(Suppl 1):S29. DOI:10.1186/1471-2482-12-S1-S29 · 1.40 Impact Factor
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    • "Despite the fact that most patients with jejunal diverticulosis remain completely asymptomatic, complications are reported in 10% to 30% of patients [8-10]. These include chronic abdominal pain, malabsorption, hemorrhage, diverticulitis, bowel obstruction, abscess formation, and, rarely, diverticular perforation [11]. Phytobezoar in a jejunal diverticulum is an extremely rare presentation. "
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    ABSTRACT: Phytobezoars are concretions of poorly digested fruit and vegetable fibers found in the alimentary tract. Previous gastric resection, gastrojejunostomy, or pyloroplasty predispose people to bezoar formation. Small-bowel bezoars normally come from the stomach, and primary small-bowel bezoars are very rare. They are seen only in patients with underlying small-bowel diseases such as diverticula, strictures, or tumors. Primary small-bowel bezoars almost always present as intestinal obstructions, although it is a very rare cause, being responsible for less than 3% of all small-bowel obstructions in one series. Jejunal diverticula are rare, with an incidence of less than 0.5%. They are usually asymptomatic pseudodiverticula of pulsion type, and complications are reported in 10% to 30% of patients. A phytobezoar in a jejunal diverticulum is an extremely rare presentation. A 78-year-old Pakistani man presented to our clinic with small-bowel obstruction. Upon exploration, we found a primary small-bowel bezoar originating in a jejunal diverticulum and causing jejunal obstruction. Resection and anastomosis of the jejunal segment harboring the diverticulum was performed, and our patient had an uneventful recovery. Primary small-bowel bezoars are very rare but must be kept in mind as a possible cause of small-bowel obstruction.
    Journal of Medical Case Reports 09/2011; 5(1):482. DOI:10.1186/1752-1947-5-482
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