Abstract
In contrast to the diverticulosis of the colon, jejunal diverticulosis is a rare condition. The incidence is 0.06-5% in large autopsy series. Complicated diverticulosis jejuni (CDJ) often presents with unspecific symptoms. Therefore, diagnosis is often a challenging process and due to the clinical rarity generally valid recommendation of perioperative management does not exist. We considered only patients who were operated in our center between April 2007 and August 2014. Patients were identified by data bank search via International Statistical Classification of Diseases and Related Health Problems diagnosis code K57.10. Data were manually screened, and patients with Meckel's and duodenal diverticula were excluded from this study. Eleven consecutive patients with CDJ were finally included in this study. We analyzed symptoms, diagnostic procedures, surgical treatment, and postoperative morbidity and mortality. The median age of our patients was 76 years (range: 34-87). CDJ presented most frequently as intestinal bleeding or as diverticulitis. Clinical symptoms were unspecific abdominal pain, hematemesis or melena, ileus, nausea, and emesis as well as patients with acute abdomen. Esophagogastroduodenoscopies confirmed CDJ in two of the three patients. An abdominal computed tomography scan only helped to diagnose CDJ in two of the 10 patients. Eight (72.7%) patients received an open segmental resection with primary anastomosis. In three (27.3%) cases, a reoperation was necessary. Overall morbidity rate was 45.5%, and perioperative mortality was 9.1%. Due to the acute character of the disease, patients with CDJ are seriously ill. To diagnose patients with CDJ remains challenging as diagnostic investigations are usually not helpful in confirming the diagnosis. Still, diagnosis of CDJ is most frequently confirmed intraoperatively.
Highlights
In contrast to the diverticulosis of the colon, jejunal diverticulosis is a rare disease
In contrast to the diverticulosis of the colon that can often be diagnosed by its typical clinical presentation and symptoms, the complicated diverticulosis jejuni (CDJ) displays unspecific symptoms
We focused on the preoperative symptoms and the non-clinical diagnostics with respective to their predictive value, operative strategies, postoperative events and outcomes, as well as in-hospital mortality
Summary
In contrast to the diverticulosis of the colon, jejunal diverticulosis is a rare disease. In contrast to the diverticulosis of the colon that can often be diagnosed by its typical clinical presentation and symptoms, the CDJ displays unspecific symptoms. This is due to the relatively variable anatomic location of the small bowel. Previous studies could not identify typical symptoms in these patients that might result in further specific diagnostic and therapy [5, 6] Such early diagnostic might be favorable as perforation or bleeding can result in severe patients’ condition. Such a complication can result in a mortality rate in previously published articles that ranges between 24 and 40% [7,8,9]. Diagnosis is often a challenging process and due to the clinical rarity generally valid recommendation of perioperative management does not exist
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