Jejunal Diverticulosis Is a Rather Difficult Diagnosis: Report of a Case and Review of the Literature
Journal of Surgery
Volume 7, Issue 1, February 2019, Pages: 8-13
Received: Jan. 9, 2019;
Accepted: Mar. 1, 2019;
Published: Mar. 21, 2019
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Georgios Delimpaltadakis, Department of Surgery, Venizeleio General Hospital, Heraklion, Greece
Kalliopi Strataki, Department of Surgery, Venizeleio General Hospital, Heraklion, Greece
Konstantinos Spiridakis, Department of Surgery, Venizeleio General Hospital, Heraklion, Greece
Theodoros Papadakis, Department of Surgery, Venizeleio General Hospital, Heraklion, Greece
Eleni Kaloeidi, Department of Surgery, Venizeleio General Hospital, Heraklion, Greece
Eleni Tsagkataki, Department of Surgery, Venizeleio General Hospital, Heraklion, Greece
Jejunal diverticulosis is most commonly an incidental intraoperative finding, while rarely can be a clinical diagnosis as demonstrated in our case and on published articles in the literature. Besides the rarity of the disease, a second factor that incommodes the preoperative diagnosis is the vague symptomatology. The case of a 72-year-old male patient is described, who was complaining for mild intensity abdominal pain, with no other specific symptoms. A leucocytosis of 12.500/mm3 was revealed, with all other laboratory tests being within normal limits. CT scan showed bubbles of free air in abdominal cavity and the decision for surgical exploration was taken. In the operating room multiple large diverticula were found along the jejunum without obvious perforation. A resection of 105 cm of jejunum was performed. Patient’s postoperative recovery was uneventful and two years later he does not complain of any abdominal symptoms. Postoperatively an expert radiologist was asked to read and explain the preoperative CT scan. Radiologist’s diagnosis was that the patient had either multiple jejunal diverticula or trapped free air in peritoneal cavity. Consequently, the preoperative diagnosis is feasible with a prompt cooperation between surgeon and radiologist and a better interpretation of CT scan findings from the radiologist.
Jejunal Diverticulosis Is a Rather Difficult Diagnosis: Report of a Case and Review of the Literature, Journal of Surgery.
Vol. 7, No. 1,
2019, pp. 8-13.
Williams, R. A., et al., Surgical problems of diverticula of the small intestine. Surg Gynecol Obstet, 1981. 152(5): p. 621-6.
Alam, S., A. Rana, and R. Pervez, Jejunal diverticulitis: imaging to management. Ann Saudi Med, 2014. 34(1): p. 87-90.
Singal, R., S. Gupta, and A. Airon, Giant and multiple jejunal diverticula presenting as peritonitis a significant challenging disorder. J Med Life, 2012. 5(3): p. 308-10.
Drude, R. B., Jr., et al., Malabsorption in jejunal diverticulosis treated with resection of the diverticula. Dig Dis Sci, 1980. 25(10): p. 802-6.
Nakayama Y., e. a., Perforated Jejunal Diverticulum Treated by Exteriorization in An Adult Patient with Alcoholic Psychosis: A Case Report. Journal of Gastroenterology and Hepatology Research, 2017. 6.
Horton, K. M., F. M. Corl, and E. K. Fishman, CT of nonneoplastic diseases of the small bowel: spectrum of disease. J Comput Assist Tomogr, 1999. 23(3): p. 417-28.
Fintelmann, F., M. S. Levine, and S. E. Rubesin, Jejunal diverticulosis: findings on CT in 28 patients. AJR Am J Roentgenol, 2008. 190(5): p. 1286-90.
Macari, M., et al., CT of jejunal diverticulitis: imaging findings, differential diagnosis, and clinical management. Clin Radiol, 2007. 62(1): p. 73-7.
Coulier, B., et al., Diverticulitis of the small bowel: CT diagnosis. Abdom Imaging, 2007. 32(2): p. 228-33.
Chou, C. K., et al., CT of large small-bowel diverticulum. Abdom Imaging, 1998. 23(2): p. 132-4.
Lebert, P., et al., Acute Jejunoileal Diverticulitis: Multicenter Descriptive Study of 33 Patients. AJR Am J Roentgenol, 2018. 210(6): p. 1245-1251.
Ross, C. B., et al., Diverticular disease of the jejunum and its complications. Am Surg, 1990. 56(5): p. 319-24.
Noer, T., Non-Meckelian diverticula of the small bowel. The incidence in an autopsy material. Acta Chir Scand, 1960. 120: p. 175-9.
Kongara, K. R. and E. E. Soffer, Intestinal motility in small bowel diverticulosis: a case report and review of the literature. J Clin Gastroenterol, 2000. 30(1): p. 84-6.
Weston, S., et al., Clinical and upper gastrointestinal motility features in systemic sclerosis and related disorders. Am J Gastroenterol, 1998. 93(7): p. 1085-9.
Ng, S. B. and I. A. Busmanis, Rare presentation of intestinal amyloidosis with acute intestinal pseudo-obstruction and perforation. J Clin Pathol, 2002. 55(11): p. 876.
Zuber-Jerger, I., E. Endlicher, and F. Kullmann, Bleeding jejunal diverticulosis in a patient with myasthenia gravis. Diagn Ther Endosc, 2008. 2008: p. 156496.
Cunliffe, W. J. and J. Anderson, Case of cronkhite--Canada syndrome with associated jejunal diverticulosis. Br Med J, 1967. 4(5579): p. 601-2.
McLean, A. M., et al., Malabsorption in Marfan (Ehlers-Danlos) syndrome. J Clin Gastroenterol, 1985. 7(4): p. 304-8.
Shapira O., e. a., Multiple Giant Gastrointestinal Diverticula Complicated by Perforated Jejunoileal Diverticulitis in Marfan Syndrome. ResearchGate, 1992.
Friedman, L. S., et al., Jejunal diverticulosis with perforation as a complication of Fabry's disease. Gastroenterology, 1984. 86(3): p. 558-63.
Andersen, L. P., B. Schjoldager, and B. Halver, Jejunal diverticulosis in a family. Scand J Gastroenterol, 1988. 23(6): p. 672-4.
Koch, A. D. and E. J. Schoon, Extensive jejunal diverticulosis in a family, a matter of inheritance? Neth J Med, 2007. 65(4): p. 154-5.
Gupta, S. and N. Kumar, Jejunal diverticula with perforation in non steroidal anti inflammatory drug user: A case report. Int J Surg Case Rep, 2017. 38: p. 111-114.
Chow, D. C., M. Babaian, and H. L. Taubin, Jejunoileal diverticula. Gastroenterologist, 1997. 5(1): p. 78-84.
Wilcox, R. D. and C. H. Shatney, Surgical implications of jejunal diverticula. South Med J, 1988. 81(11): p. 1386-91.
Akhrass, R., et al., Small-bowel diverticulosis: perceptions and reality. J Am Coll Surg, 1997. 184(4): p. 383-8.
Staszewicz, W., et al., Acute ulcerative jejunal diverticulitis: case report of an uncommon entity. World J Gastroenterol, 2008. 14(40): p. 6265-7.
Altemeier, W. A., L. R. Bryant, and J. H. Wulsin, The surgical significance of jejunal diverticulosis. Arch Surg, 1963. 86: p. 732-45.
Pani JR, R. S., Multiple jejunal diverticulitis presenting with acute intestinal obstruction: a diagnostic dilemma. International Surgery Journal, 2016.
Rodriguez, H. E., et al., Jejunal diverticulosis and gastrointestinal bleeding. J Clin Gastroenterol, 2001. 33(5): p. 412-4.
Tsiotos, G. G., M. B. Farnell, and D. M. Ilstrup, Nonmeckelian jejunal or ileal diverticulosis: an analysis of 112 cases. Surgery, 1994. 116(4): p. 726-31; discussion 731-2.
Edwards, H. C., Diverticula of the small intestine. Br J Radiol, 1949. 22(260): p. 437-42.
Shimayama, T., J. Ono, and T. Katsuki, Iron deficiency anemia caused by a giant jejunal diverticulum. Jpn J Surg, 1984. 14(2): p. 146-9.
Bures, J., et al., Small intestinal bacterial overgrowth syndrome. World J Gastroenterol, 2010. 16(24): p. 2978-90.
Hanna, C., et al., Jejunal diverticulosis found in a patient with long-standing pneumoperitoneum and pseudo-obstruction on imaging: a case report. Gastroenterol Rep (Oxf), 2016. 4(4): p. 337-340.
Schloericke, E., et al., Complicated jejunal diverticulitis: a challenging diagnosis and difficult therapy. Saudi J Gastroenterol, 2012. 18(2): p. 122-8.
Jerraya H., e. a., Case Report Open Access Jejunal Diverticulitis: A Challenging Diagnosis. Journal of Gastrointestinal & Digestive System, 2015.
Yen, H. H. and Y. Y. Chen, Jejunal diverticulosis: a limiting condition to double-balloon enteroscopy. Gastrointest Endosc, 2006. 64(5): p. 847; author reply 847-8.
Gaba, R. C., P. K. Schlesinger, and A. C. Wilbur, Endoscopic video capsules: radiologic findings of spontaneous entrapment in small intestinal diverticula. AJR Am J Roentgenol, 2005. 185(4): p. 1048-50.
Benya, E. C., G. G. Ghahremani, and J. J. Brosnan, Diverticulitis of the jejunum: clinical and radiological features. Gastrointest Radiol, 1991. 16(1): p. 24-8.
Mansoori, B., et al., Magnetic resonance enterography/enteroclysis in acquired small bowel diverticulitis and small bowel diverticulosis. Eur Radiol, 2016. 26(9): p. 2881-91.
Novak, J. S., J. Tobias, and J. S. Barkin, Nonsurgical management of acute jejunal diverticulitis: a review. Am J Gastroenterol, 1997. 92(10): p. 1929-31.
Harbi, H., et al., Jejunal diverticulitis. Review and treatment algorithm. Presse Med, 2017. 46(12 Pt 1): p. 1139-1143.
Cross, M. J. and S. K. Snyder, Laparoscopic-directed small bowel resection for jejunal diverticulitis with perforation. J Laparoendosc Surg, 1993. 3(1): p. 47-9.
Wilcox, R. D. and C. H. Shatney, Surgical significance of acquired ileal diverticulosis. Am Surg, 1990. 56(4): p. 222-5.
Sehgal, R., et al., Perforated jejunal diverticulum: a rare case of acute abdomen. J Surg Case Rep, 2016. 2016(10).