Perforated Diverticulum Research Articles

Why Does Diverticulitis Perforate?

Diverticular disease is a common entity in the western world with an increasing incidence globally. This probably reflects both an increase in detection and an ageing population. The pathophysiology of diverticular disease is likely multifactorial involving dietary habits, changes in colonic pressures and motility, and colon wall structural changes. Not only has the understanding of the natural history of the disease become more complex than previously believed but the treatment algorithms have also evolved. Management paradigms are changing and are increasingly challenging, particularly for complicated diverticulitis. While the prevalence of diverticulitis is increasing, its pathogenesis and natural history have received little attention. The aim of this article is to review the current literature regarding the pathogenesis of diverticular perforation and highlight the fact that there is limited data regarding its pathophysiology.

Gut wall replacing type of gastrointestinal stromal tumor presenting as a perforation of the ileal diverticulum

Gastrointestinal stromal tumors (GISTs) usually form a well-circumscribed mass. Very rarely, however, sporadic GISTs show gut-wall replacing growth, similar to the diffuse hyperplasia of interstitial cells of Cajal (ICC) observed in patients with neurofibromatosis type 1 (NF1) and hereditary GIST. Here we describe a patient with ileal perforation caused by this unusual type of GIST. An 82-year-old man was admitted to the emergency department with sudden abdominal pain. Following a provisional diagnosis of perforation of Meckel's diverticulum, he underwent segmental resection of the small intestine. Macroscopic examination revealed a diverticulum-like structure 2.5cm in size near the site of mesenteric attachment of the ileum. Histological examination showed diffuse and nodular proliferation of spindle cells positive for c-KIT and CD34 that had replaced the muscularis propria of the small intestine. Mutational analyses of the lesions revealed monoclonality of proliferating cells with a somatic mutation in c-kit exon 11 (p.Leu576Pro). Gut-wall replacing type of GIST should be recognized as a specific type of GIST causing diverticulum-like structures of the gastrointestinal tract.

Perforated Jejunal Diverticulum: A Rare Cause of Acute Abdomen in Elderly Patient

Jejunal diverticula are rare, acquired lesions seen in elderly patients. Most of the cases are asymptomatic, and are generally detected incidentally. Symptoms, if present, include nonspecific chronic abdominal pain and malabsorption. They may be associated with complications like hemorrhage, diverticulitis, obstruction or perforation. Diverticular perforation is rare, occurring only in around 5-6% of all patients. We present a rare case of 76 year old male with acute abdomen associated with jejunal diverticular perforation and review the literature on this complication.

English

Jejunal diverticulosis is generally seen in elderly patients, and is relatively rare. Jejunal diverticula are generally asymptomatic, thus are usually only incidentally detected. Jejunal diverticulosis is sometimes associated with complications like small bowel obstruction, bleeding, or perforation. We present a case report of a 56 year old male who presented with jejunal diverticular perforation.

Perforation of Jejunum Diverticula: Report of Two Cases

Perforation of jejunal diverticulum is quite uncommon. Clinically this diagnosis may be easily confused with other causes of an acute abdomen. We present two cases with acute abdomen caused by perforation of jejunal diverticulum. These two patients are diagnosed and treated at different phases of the entity. Choice of surgical procedure was different in these patients. Physicians should increase the awareness of perforated jejunal diverticulum in patients with acute abdomen.

憩室穿孔を契機に発見された胆管癌術後転移性大腸癌の1例

憩室穿孔を契機に発見された胆管癌術後転移性大腸癌の1例

Left Colon Diverticulitis Presenting as Perforated Lumbar Abscess: A Case Report and Review of the Current Literature.

Diverticular perforation is a common complication of diverticulitis and can lead to the creation of abscesses. The presence of such abscesses on the abdominal wall is rare and can lead to misdiagnosis. We present the case of a patient with abdominal pain and the formation of a large left lumbar abscess due to perforation of a diverticulum of the left colon and our surgical treatment of choice with favorable results.

イレウス管迷入によるMeckel憩室穿孔の1例

イレウス管迷入によるMeckel憩室穿孔の1例

腸切除と憩室翻転術を施行した薬剤性腸炎に起因した空腸憩室穿孔の1例

91歳，女性．下腹部痛を主訴に当院を受診．受診3カ月前にも腹痛で受診され感染性腸炎疑いで入院となった．薬剤性腸炎を続発し入院は2カ月に及んだ．身体所見では下腹部に筋性防御と圧痛あり，血液検査でWBC 44,700/μl，CRP 21.3mg/dlと炎症反応を認めた．腹部CT検査で腹腔内に多量の遊離ガスと液貯留，小腸粘膜途絶像を認め，小腸穿孔の診断で緊急手術施行した．腹腔内は膿汁で充満，Treitz靱帯より50cmの腸間膜側空腸憩室に穿孔を認め，その他空腸にも多発憩室を認めた．穿孔部含め憩室腸管を摘出，遺残憩室には翻転術を加えた．術後数日ICU管理，その後は合併症なく嚥下機能回復遅延のため術後47日目に転院となった．原因不明の消化器症状を訴える高齢患者には小腸憩室炎の可能性も考慮し，穿孔など合併症を防ぐことが重要と考えた．

Isolated perforation of Meckel′s diverticulum following blunt trauma abdomen: A rare case report

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, occurring in about 2% of the population and, in most cases, incidentally being discovered during autopsy, laparotomy, or barium studies. Hemorrhage, obstruction, and inflammation are the complications that can occur in a Meckel's diverticulum. Perforation in a Meckel's diverticulum can occur in the presence of ectopic mucosa which is rare, but perforation following blunt abdominal injury is very rare and only few cases have been reported so far. We report a case of perforation of Meckel's diverticulum in an 8-year-old boy following a blunt abdominal trauma due to fall from a bicycle.

A Rare Cause of Acute Abdomen: Perforation of Double Meckel's Diverticulum.

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. In this report, we aimed to represent a case of intestinal perforation, caused by double Meckel's diverticulum, which is a very rare entity in surgical practice. The patient was a 20-year-old Caucasian man, admitted to hospital with complaints of abdominal pain, nausea, and vomitting during the last 3 days. Physical examination indicated tenderness, rebound, and guarding in the right lower quadrant of abdomen. Abdominal X-ray revealed a few air-liquid levels in the left upper quadrant. In the operation, 2 Meckel's diverticula were observed, one at the antimesenteric side, at 70 cm distance to the ileocecal valve, approximately in 3 cm size, and the other between the mesenteric and antimesenteric sides, approximately in 5 cm size. The first one had been perforated at the tip and wrapped with omentum. A 30 cm ileal resection, including both diverticula with end-to-end anastomosis, was performed. The diagnosis of symptomatic Meckel's diverticulum is considerably hard, especially when it is complicated. Diverticulectomy or segmentary resections are therapeutic options. In patients with acute abdomen clinic, Meckel's diverticulum and its complications should be kept in mind, and the intestines should be observed for an extra diverticulum for caution although it is a very rare condition.

Spontaneous perforation of Meckel�s diverticulum: a case report and review of literature

Meckel's diverticulum is the commonest congenital abnormality of the gastrointestinal tract. Hemorrhage, obstruction and inflammation are the three main categories of complications resulting from Meckel's diverticulum. Spontaneously perforation of Meckel's diverticulum is very rare and mimics acute appendicitis. We report a case of 26 year-old male, who presented since 5 days worsening abdominal pain predominantly in the right iliac fossa associated with high grade fever. On physical examination his abdomen was distended with guarding and rigidity. A provisional diagnosis of appendiculaire peritonitis was made. Our patient had an emergency laparotomy, where a perforated Meckel's diverticulum and advanced peritonitis were discovered. A diverticulectomy with ileostomy were performed. Heterotopic mucosa of diverticulitis was confirmed on histopathology. The patient made an uneventful recovery postoperatively and ileostomy reconstruction was done two months later. This case report is an interesting and unusual case of Meckel's diverticulum complications and highlights the importance of considering Meckel's diverticulum as a differential diagnosis in every patient presenting with acute abdomen.

Perforation of Meckel's diverticulum with peritonitis: rare case report and review of literature

Meckel’s Diverticulum (MD) is the most common congenital anomaly of the small bowel found in 2% of population. The majority of patients with this anomaly will remain asymptomatic; however, several complications can occur, including obstruction, intussusceptions, hemorrhage and diverticulitis. Perforation of Meckel’s diverticulum is rare complication occurring in less than 7% of patients complicated by Meckel’s diverticulum that can often mimic appendicitis. Preoperative diagnosis of perforated Meckel’s diverticulum remains a challenging issue. This case demonstrates that a healthy degree of suspicion for complicated Meckel’s diverticulum should be present when dealing with a questionable diagnosis of appendicitis. We report case of 19 years old boy who presented to emergency department with abdominal pain in right lower quadrant mimicking perforated appendicitis. Exploratory laparotomy disclosed normal appendix and perforation of Meckel’s diverticulum.

Perforated Meckel′s diverticulum as a result of gastrointestinal stromal tumor presenting as acute abdomen: A rare case report

Meckel's diverticulum is present on the antimesentric border of the terminal ileum, within 2 ft proximal to the ileocecal valve, and results from incomplete closure of the vitello-intestinal duct. Meckel's diverticulum is usually diagnosed during laparotomy or due to a complication of it such as bleeding, diverticulitis, and perforation. Tumors within Meckel's diverticulum are a rare, but known complication. A 50-year-old male presented with fever and pain abdomen particularly in periumbilical region with sign of peritonitis. During laparotomy, a perforated Meckel's diverticulum was found. A perforation was found at the apex of Meckel's diverticulum. We resected 5 cm of the healthy bowel each side with primary anastomosis. Histopathology and immune-histochemistry shows gastrointestinal stromal tumors (GISTs) of Meckel's diverticulum. GISTs arising from Meckel's diverticulum are an extremely rare, but recognized complication. Surgery is the standard treatment for nonmetastatic GISTs with en bloc resection and clear margins.

A Case of Duodenal Diverticular Perforation Successfully Managed by Conservative Therapy

A Case of Duodenal Diverticular Perforation Successfully Managed by Conservative Therapy

A Case of Emergency Laparoscopic Surgery Involving Anterior Resection for Diverticular Perforation in a Patient with Situs Inversus Totalis

A Case of Emergency Laparoscopic Surgery Involving Anterior Resection for Diverticular Perforation in a Patient with Situs Inversus Totalis

A Case of Diverticular Perforation in a Young Patient with Rheumatoid Arthritis on Methotrexate.

Background. Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate (MTX), are associated with gastrointestinal toxicity. MTX inhibits dihydrofolate reductase, but it is unclear if polymorphisms of the methylenetetrahydrofolate reductase (MTHFR) gene predict toxicity. Case. We describe a 33-year-old male with polyarticular rheumatoid arthritis who developed sigmoid diverticular perforation while receiving methotrexate, folic acid, prednisone, and naproxen. He tested heterozygous for the C677T allele MTHFR gene. Discussion. Rheumatoid arthritis and its treatments are associated with increased risk of gastrointestinal disease. In one study, perforation was highest among individuals with concomitant exposure to NSAIDs, nonbiologic DMARDs, and glucocorticoids. Multiple mutations of the MTHFR gene have been identified, but their association with MTX toxicity is unclear. This case adds to a growing body of literature that could help inform the treatment of others in the future.

Laparoscopic peritoneal lavage: a definitive treatment for diverticular peritonitis or a "bridge" to elective laparoscopic sigmoidectomy?: a systematic review.

To this day, the treatment of generalized peritonitis secondary to diverticular perforation is still controversial. Recently, in patients with acute sigmoid diverticulitis, laparoscopic lavage and drainage has gained a wide interest as an alternative to resection. Based on this backdrop, we decided to perform a systematic review of the literature to evaluate the safety, feasibility, and efficacy of peritoneal lavage in perforated diverticular disease.A bibliographic search was performed in PubMed for case series and comparative studies published between January 1992 and February 2014 describing laparoscopic peritoneal lavage in patients with perforated diverticulitis.A total of 19 articles consisting of 10 cohort studies, 8 case series, and 1 controlled clinical trial met the inclusion criteria and were reviewed. In total these studies analyzed data from 871 patients. The mean follow-up time ranged from 1.5 to 96 months when reported. In 11 studies, the success rate of laparoscopic peritoneal lavage, defined as patients alive without surgical treatment for a recurrent episode of diverticulitis, was 24.3%. In patients with Hinchey stage III diverticulitis, the incidence of laparotomy conversion was 1%, whereas in patients with stage IV it was 45%. The 30-day postoperative mortality rate was 2.9%. The 30-day postoperative reintervention rate was 4.9%, whereas 2% of patients required a percutaneous drainage. Readmission rate after the first hospitalization for recurrent diverticulitis was 6%. Most patients who were readmitted (69%) required redo surgery. A 2-stage laparoscopic intervention was performed in 18.3% of patients.Laparoscopic peritoneal lavage should be considered an effective and safe option for the treatment of patients with sigmoid diverticulitis with Hinchey stage III peritonitis; it can also be consider as a “bridge” surgical step combined with a delayed and elective laparoscopic sigmoidectomy in order to avoid a Hartmann procedure. This minimally invasive staged approach should be considered for patients without systemic toxicity and in centers experienced in minimally invasive surgery techniques. Further evidence is needed, and the ongoing RCTs will better define the role of the laparoscopic peritoneal lavage/drainage in the treatment of patients with complicated diverticulitis.

A Rare Clinic Entity: Jejunal Diverticular Perforation and Ileus

DOI: 10.4328/JCAM.826 Received: 25.11.2011 Accepted: 02.01.2012 Printed: 01.01.2015 J Clin Anal Med 2015;6(1): 109-11 Corresponding Author: Erhan Dedeoglu, Department of Emergency Medicine, Canakkale Public Hospital, Canakkale Devlet Hastanesi, Acil Servis, Canakkale, Turkiye. GSM: +905054423119 E-Mail: drerhandedeoglu@yahoo.com Ozet Jejunal divertikulleri cok nadirdir ve genellikle asemptomatiktir. Bu asemptomatik divertikullere laparatomi esnasinda veya cesitli radyolojik goruntuleme calismalari esnasinda tesadufen rastlanir. Akut komplikasyonlarin tanisindaki gecikmenin mortalite ve morbiditede belirgin artisa neden olmasi ve nadir gorulmesi nedeni ile acil servise akut karin tablosu gelen ve laparotomiye alinan jejunal divertikulozis tanisi konulan iki olgunun sunulmasi amaclandi.

A Rare Case of Perforated Meckels Diverticulum Following Blunt Abdominal Trauma in a Child

Perforation of Meckel’s diverticulum following blunt abdominal trauma is quite rare. Only 4 cases have been reported in literature of Meckel’s diverticulum perforation following blunt abdominal trauma .Here we report a case of Meckel’s diverticulum perforation in a 10 yr old male child who presented in emergency with history of blunt abdominal trauma with bicycle handle. The patient had generalized tenderness and guarding all over abdomen and X-ray abdomen showed pneumoperitoneum. On exploration, there was perforated Meckel’s diverticulum for which wedge resection and primary suturing was done.