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Jejunal Diverticulitis

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Serhat Dogan
Serhat Dogan
Serhat Dogan
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Mehmet Erikoglu
Mehmet Erikoglu
Mehmet Erikoglu
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J Turgut Ozal Med Cent
DOI: 10.5455/jtomc.2017.11.143 2018;25(1):161
Jejunal diverticulitis
Serhat Dogan1, Mehmet Erikoglu2
1Malatya Educatin and Research Hospital, General Surgery Department, Malatya, Turkey
2Necmettin Erbakan University Meram Medical Faculty, Department of General Surgery, Konya, Turkey
Dear Editor,
Jejunal diverticulosis is the least common type of small
bowel diverticula, incidence is less than 0.5% (1). Jejunal
diverticulitis (JD) was rst reported in 1807 by Sir Astley
Paston Cooper. Autopsy studies reveal an incidence
between 1.3% and 4.6%, whereas radiologic studies
show an incidence between 0.02% and 2.3% (2). Major
complications include diverticulitis, gastro intestinal
hemorrhage, intestinal obstruction, acute perforation.
Mortality is influenced by patients’ age, nature of
complications, and time of intervention. Common acute
complications include diverticulitis, bleeding, intestinal
obstruction and perforation (3). The mortality rate of
complicated jejunal disease has ranged between 21% and
30% over the past 30 years (4); however, some reviews
indicate a mortality rate between 0% and 5% (5). These
reviews may reflect improvements in intensive care
management and antimicrobial treatment.
In this case thirty ve years old male patient with a
complaint of a day earlier with abdominal pain, nausea and
loss of appetite were admitted to our clinic. The patient did
not have any previous history for diease and operation.
On physical examination, 37 °C tempature, heart rate 100/
min, blood pressure 90/50mm Hg and respiratory rate
16 breaths/min., Oxygen saturation of 97% on room air.
Had hypoactive bowel sounds and abdominal tenderness
positive. Rebound and defense has been detected in the
right lower abdomen. Laboratory ndings, white blood cell
levels 13000/ mm3 and other parameters were normal.
Standing in direct abdominal X-ray bowel air-fluid levels
detected. Ultrasonography (USG) examination revealed
minimal fluid collection between intestinal loops.The
present ndings resembled appendicitis. We performed
diagnostic laparoscopy Inspectional ndings for appendix
was normal, but purulent contents were detected among
intestinal loops. But we did not nd any pathology explain
this purulant liquid. So we performed laparatomy. We
found JD had settled on to the mesentery 60 cm from
Treitz. (Figure 1)
There was inflammation around diverticulitis. There is no
perforation so resection was not considered. Abdomen
was washed with plenty of SF and operation has been
terminated. After surgery antibiotic therapy was started.
Oral intake was stopped for two days. Than oral regime
was opened on the third day. Abdominal examination
was completely normal and post-operative fourth day the
patient was discharged.
Figure 1. Jejunal diverticulitis in operation
As a result, the JD is rare and difcult to diagnose. Although
conservative medical management may be attempted
for stable patients, surgical resection of involved bowel
segments is the standard of care for patients with
recurrent symptoms who have undergone unsuccessful
medical management or have complications. Mesenteric
localized JD confused with other disorders causing acute
abdominal pain and may cause unnecessary laparotomies.
We should kept in mind that JD may be among the causes
of acute abdomen. In addition, diagnostic laparoscopy
can be a valuable diagnostic tool in complex cases.
REFERENCES
1. Zager JS, Garbus JE, Shaw JP, Cohen MG, Garber SM. Jejunal
diverticulosis: a rare entity with multiple presentations, a
series of cases. Dig Surg 2000;17(6);643-5.
2. Ross CB, Richards WO, Sharp KW, Bertram PD, Schaper PW.
Diverticular disease of the jejunum and its complications.
Am Surg. 1990;56(5);319-24.
3. Woods K, Williams E, Melvin W, Sharp K. Acquired jejunoileal
diverticulosis and its complications: a review of the
literature. Am Surg. 2008;74(9);849-54.
4. Chendrasekhar A, Timberlake GA. Perforated jejunal
diverticula: an analysis of reported cases. Am Surg
1995;61(11);984-8.
5. Akhrass R, Yaffe MB, Fischer C, Ponsky J, Shuck JM. Small-
bowel diverticulosis: perceptions and reality. J Am Coll Surg
1997;184(4);383-8.
Received: 13.11.2017 Accepted: 13.12.2017
Corresponding Author: Serhat Dogan, Malatya Educatin and Research Hospital, General Surgery Department, Malatya, Turkey
E-mail: drserhatdogan@gmail.com
161
Letter to the Editor
ResearchGate has not been able to resolve any citations for this publication.
Acquired Jejunoileal Diverticulosis and Its Complications: A Review of the Literature
Article
  • Oct 2008
  • AM SURGEON
Jejunoileal diverticulosis is a rare entity. Jejunoileal diverticulosis is not a disease that surgeons see often in clinical practice; however, it should remain on the differential diagnosis for any patient with an acute abdomen or gastrointestinal bleeding of unknown origin. It can present with a wide range of clinical scenarios and when patients experience chronic symptoms such as bloating, abdominal pain, nausea, bacterial overgrowth, or malabsorption, medical therapy is successful in most patients. However, when patients present with acute symptoms of bleeding, inflammation, perforation, or obstruction, surgical resection and primary anastomosis is often the treatment of choice. If patients are asymptomatic, they are better left alone, even when discovered incidentally in the operating room. In closing, the possibility of a patient having jejunal diverticular disease should be suspected whenever the symptoms of obscure abdominal pain, anemia, dilated jejunal loops on abdominal radiographs, a history of colonic diverticuli, and a history of acute appendicitis.
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Diverticular disease of the jejunum and its complications
Article
  • Jun 1990
  • AM SURGEON
Jejunal diverticulosis is an uncommon, acquired condition that has been encountered recently in four patients. These cases (two patients with diverticulitis, one patient with chronic abdominal pain, and one patient incidentally discovered at laparotomy for colonic diverticulitis) are reported. Acute complications of jejunal diverticulosis include diverticulitis, bleeding, and intestinal obstruction. Chronic complications include intractable abdominal pain, malabsorption, and intestinal pseudo-obstruction. Up to 15 per cent of patients with jejunal diverticulosis may require small-bowel resection for treatment of these acute or chronic complications. The clinical significance, proper diagnostic evaluation, and treatment of jejunal diverticular disease are reviewed.
View
Perforated jejunal diverticula: An analysis of reported cases
Article
  • Dec 1995
  • AM SURGEON
We recently encountered two cases of perforated jejunal diverticula. We analyzed the data from all available cases of perforated jejunal diverticula, including our two cases. Our purpose was to increase awareness of this rare clinical entity as a cause of abdominal pain. An extensive literature review using Medline from its inception in 1972, and a manual review of all previously published reports was performed. Data collected included age, gender, length of symptoms from history and physical exam, operative findings, type of operation, and outcome (survival). Data analysis was performed using student's t test and multivariate analysis. Survival was not influenced by gender or type of operation. When the reports documented the number of diverticula present in the area of perforation (22 cases) a majority (19/22) had multiple diverticula. Perforated jejunal diverticula are a rare clinical entity in which age, type of operation, and gender does not influence outcome, but a longer duration of symptoms before operation trended towards a worse outcome. This clinical diagnosis should be entertained as part of any evaluation of abdominal pain.
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Small-bowel diverticulosis: Perceptions and reality
Article
  • May 1997
Small-bowel diverticulosis is a rare entity that can be discovered incidentally during celiotomy, endoscopy, or radiographic imaging studies. The reported complication rate is low, giving rise to the current recommendation not to treat uncomplicated small-bowel diverticula. A retrospective review was performed of patients with small-bowel diverticulosis seen during 23 years at three major institutions. Two hundred eight patients were identified. Diverticula were located in the duodenum in 79 percent; in the jejunum or ileum in 18 percent; and in duodenum, jejunum, and ileum in 3 percent. Complications developed in 42 of the 208 patients (20 percent) including bleeding in 14, diverticulitis with perforation and abscess formation in 12, and malabsorption in 8. When assessed by location, jejunoileal diverticula were more likely to have complications than duodenal diverticula: 46 percent compared to 13 percent (p < .01). Bleeding accounted for 52 percent of the duodenal complications compared to 12 percent of the jejunoileal complications (p < 05). Jejunoileal diverticula were more likely to perforate and develop abscesses (21 percent compared to 1.2 percent; p < .001). The low incidence of complications associated with duodenal diverticula justifies a nonoperative approach. The higher complication rate associated with jejunoileal diverticula will be necessary to define that approach more exactly.
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Jejunal Diverticulosis: A Rare Entity with Multiple Presentations, a Series of Cases
Article
  • Feb 2000
  • DIGEST SURG
Jejunal diverticulosis (JD) is a rare disease that has a variable presentation. The signs, symptoms, diagnosis, complications and treatment of JD will be discussed through a review of the literature and a series of cases from our own institution. A retrospective analysis of the diagnosis, treatment and complications of JD was performed by a literature review. This was accompanied by a series of four cases of JD diagnosed and treated in our own institution. JD is a rare disease in which most patients are asymptomatic. However, JD's different complications are serious and can be fatal. The treatment is mainly surgical; however, there have been cases where nonsurgical management was successful.
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