Perforated Jejunal Diverticulitis Research Articles

Perforated Jejunal Diverticulitis in an Elderly Pacient: A Case Report

Perforated Jejunal Diverticulitis in an Elderly Pacient: A Case Report

Non-operative management of perforated jejunal diverticulitis

Non-operative management of perforated jejunal diverticulitis

S3493 Two Cases of Perforated Jejunal Diverticulum With Severe COVID-19

Introduction: Jejunoileal diverticulitis is very rare with a high mortality rate of 21-40%. The rates of small bowel diverticulitis with perforation associated with COVID are unknown. Here, we present cases of complicated jejunal diverticulitis with perforation in two patients with severe COVID infection. Case Description/Methods: The first patient is a 69-year-old man who presented to our Emergency Department with shortness of breath, cough, and diarrhea. He was diagnosed with severe COVID-19 despite being vaccinated. He was started on methylprednisolone and remdesivir. 13 days into admission, the patient developed pneumomediastinum. Computed Tomography Abdomen/Pelvis (CT A/P) for further evaluation showed pneumoperitoneum and perforated jejunal diverticulitis. Given the severity of COVID pneumonia requiring high-flow oxygen, continued use of corticosteroids (methylprednisolone 40mg BID), and risk of surgical complications with COVID, conservative management with antibiotics and bowel rest was pursued. The patient developed an abscess in the mesentery and pelvis for which a drain was placed percutaneously by Interventional Radiology. He unfortunately developed progression of the perforation and passed away from septic shock. The second patient is a 57-year-old male with hypertension, deep vein thrombosis who presented with worsening shortness of breath, cough, fever. He was diagnosed with severe COVID (unvaccinated) and started on baracitinib, remdesivir, methylprednisolone. Ten days into admission he developed severe abdominal pain, nausea, vomiting, and worsening leukocytosis. CT A/P showed new abscess involving the left upper quadrant with a contained jejunal perforation. The patient was initially managed with bowel rest, antibiotics and pain control. However, he developed worsening leukocytosis and pain with peritonitis on exam. He was taken emergently to the operating room and had proximal perforated jejunum resection and lysis of adhesions. He ultimately had small bowel re-anastomosis. He continued to improve clinically and was discharged home. (Figure) Discussion: It is unclear if the complication of perforated diverticulum in these cases is due to the underlying inflammatory response due to COVID, steroid-induced disruption of intestinal mucosal barrier or incidental diverticulitis with evolution to complicated perforation. However, each case reminds us how important it is to take abdominal complaints in COVID seriously as jejunoileal diverticulitis has a high mortality rate.Figure 1.: Left panel- Patient 1 CT Abdomen/Pelvis transverse view showing jejunal perforation with surrounding inflammation (arrow). Right panel- Patient 2 CT Abdomen/Pelvis transverse view showing thickened loops of jejunum with interloop abscess (arrow).

S3457 Perforated Jejunal Diverticulitis With a Coloenteric Fistula Misdiagnosed as Gastroenteritis

S3457 Perforated Jejunal Diverticulitis With a Coloenteric Fistula Misdiagnosed as Gastroenteritis

Acute Abdomen caused by Perforated Jejunal Diverticulitis

Jejunal diverticulum accounts for only 25% of small bowel diverticula, and approximately 7% of these will present as complicated jejunal diverticulitis or perforation. Here, we described a case of jejunal diverticular perforation presented as acute abdominal peritonitis. The computed tomography of the abdomen suggested small bowel perforation and therefore, emergency surgical exploration was performed. Intraoperatively, multiple jejunal diverticulae were found with one forming a localised diverticular abscess. Segmental resection of the diseased segment with primary anastomosis was performed. The patient made an uneventful post-operative recovery. Although complicated jejunal diverticulitis is rare, emergency surgery is often warranted if perforation occurs. Computed tomography is valuable in the diagnosis and preoperative planning especially in an emergency surgical conundrum when there is equivocal clinical peritonitis or perforation.

Spontaneous Rupture of Spleen - A Rare Case Report

Spleen is highly vascular organ & non traumatic spleen rupture is rare association. Non traumatic splenic rupture has pathologic association with few diseases which cause splenomegaly followed by rupture. This case report describes the first and rare incidence of non-traumatic splenic rupture in a case of concealed perforated jejunal diverticulitis.

Perforated diverticulitis in a patient with very proximal jejunal diverticula

Background: We report a case of an elderly with peritonitis due to perforated jejunal diverticulitis, and we highlight the diagnostic evaluation and treatment alternatives. Case presentation: A 92-year-old woman was transferred to the Emergency Dept. with abdominal pain and vomiting for the past 12 hours. Physical examination revealed diffuse pain, abdominal distension, rebound tenderness and bowel silence. She was febrile, tachycardic, tachypneic, hypotensive and anuric. Blood gas estimation showed metabolic acidosis. She fulfilled the criteria of septic shock. At presentation, she was mildly malnourished. From her medical history, she had cardiac arrythmias, hypertension and diabetes mellitus under proper medication, and laparoscopic cholecystectomy. Laboratory investigations revealed Hct 44.6%, WBC 12.500/dL, glucose 300 mg/dL, creatinine 2.8 mg/dL, CRP 405 mg/L, and electrolyte deficit. Abdominal X-ray showed gastric, small intestinal and colonic gas, with no pneumoperitoneum or air-fluid levels. Chest/abdomen CT showed thickening of proximal jejunal loop and adjacent mesentery, and an extraluminal air bubble, suggesting possible perforation. The patient was given intense resuscitation and broad-spectrum antibiotics and underwent emergency laparotomy. Results: Four jejunal diverticula, sized 1-3 cm, were confined to a segment 12 cm long, located 6 cm from the Treitz ligament; the proximal diverticula was inflamed and perforated. The adjacent mesentery was inflamed and thickened; the bowel lumen remained open. We performed one-layer full-thickness suturing of the perforated diverticulum and omental patch closure. The patient was transferred intubated to ICU. E. Coli was isolated from peritoneal fluid cultures and antibiotic therapy was adjusted to antibiogram. The patient had a first bowel movement at day 5 and was extubated at day 21. She needed mild cardiopulmonary support and was discharged at day 30. Conclusions: Jejunal diverticulitis is a challenging disorder since its rarity makes diagnosis difficult and, thus delayed. The perforation of jejunal diverticulitis requires emergent surgery and poses technical dilemmas.

Laparoscopic Treatment of a Patient with Perforated Jejunal Diverticulitis

Jejunal diverticular disease is a rare but important clinical entity. Jejunal diverticula usually remain asymptomatic in 60-70% of cases and cause symptoms or surgical complications in 10-19%. Perforation of a jejunal diverticulum is infrequent and treatment has traditionally been exploratory laparotomy, with resection of the affected intestinal segment. However, the laparoscopic approach can be a good alternative in these cases, providing the known advantages of this type of surgery. We present the case of a 75-year-old man who manifested himself as an acute abdomen and who was diagnosed and treated for a jejunal diverticulum perforation by laparoscopic surgery, with good results.

Short article: Outcome of medical and surgical management for perforated jejunal diverticulitis.

Perforated jejunal diverticulitis (PJD) is rare, but it has high mortality rates. The role of nonsurgical management is debated. The aim of this study is to assess the outcomes of medical and surgical management of PJD. A single-centre study on a series of emergency patients diagnosed with PJD between 2010 and 2016 was conducted. Eleven patients with PJD were treated (seven women). Nine out of 11 were diagnosed by a computed tomography scan, and two were diagnosed at laparotomy. The initial approach was medical treatment in five patients, based on clinical and imaging findings. Four (80%) of these five patients were discharged without the need for surgical intervention. The median hospital stay was 7.5 days. Seven patients required surgery overall with a median length of hospital stay of 10.8 days. Surgical procedures consisted of segmental bowel resection and primary anastomosis in six patients and simple closure in one. There was no perioperative deaths. One patient required percutaneous drainage because of anastomotic leak, and one required reoperation owing to evisceration. Selected patients with PJD can be successfully managed with conservative approach, based on clinical and computed tomography findings.

Perforated Jejunal Diverticulitis: An Uncommon Cause of Abdominal Pain

Perforated Jejunal Diverticulitis: An Uncommon Cause of Abdominal Pain

To the O.R. and Back Again: A Case of Recurrent Jejunal Diverticulitis

A 43-year-old healthy man presented in 2015 with abdominal pain, nausea and vomiting in the context of multiple prior self-resolving episodes of abdominal pain over a four-month period. He had an acute abdomen with CT imaging remarkable for acute perforated jejunal diverticulitis. In the operating room, he was found to have a loop of bowel 55 cm from the ligament of Treitz with a perforated diverticulum. Scattered jejunal diverticula were noted. Approximately 12 cm of small bowel was resected with primary anastomosis. Pathology revealed diverticulitis, serositis, and mural abscess (Figs. 1, 2). In 2016, the patient again presented with an acute abdomen and E. coli sepsis. CT imaging was notable for recurrent jejunal diverticulitis with microperforation and non-occlusive thrombi of the superior mesenteric and portal veins. Intraoperatively, there was chronic inflammation around the previous anastomosis. He was anticoagulated for the portal vein and superior mesenteric vein thrombi for six months. In the next year, he was admitted twice with recurrent diverticulitis that was medically managed. MR enterography was done to determine if the distribution of diverticula would be amenable to a limited small bowel resection, but imaging was unable to provide accurate characterization. Ultimately, he underwent elective resection of 43 cm of small bowel with diffuse diverticular disease (Fig. 3). Jejunal diverticula are reported in 0.06-1.3% of patients in autopsy series1. They are usually multiple, localized to the proximal jejunum, and associated with disorders of motility such as systemic sclerosis, visceral neuropathies, and myopathies2. The risk of complications is higher in jejunoileal diverticula compared to duodenal diverticula, including obstruction, diverticulitis, and bleeding2. Jejunal diverticula typically present with complications requiring surgical intervention in 8-30% of cases2. If perforation, abscesses, or mechanical obstruction are seen intraoperatively, resection of the diseased bowel is the most appropriate intervention3.Figure: Representative small intestinal diverticulum located in peri-intestinal fat.Figure: Peri-diverticular fibrosis and chronic inflammatory infiltrate consistent with remote small intestinal diverticulitis.Figure: Gross specimen of resected small bowel with diffuse diverticular disease.

Intra-Abdominal Abscess Caused by Perforated Jejunal Diverticulitis: A Case Report

Jejunal diverticulitis with complication is a rare entity. Diagnosis is usually made intra-operatively. A case of 46-year-old female with acute upper abdomen is presented. Computed tomography demonstrated jejunal perforation with abscess formation. Operative findings revealed perforating jejunal diverticulitis with abscess formation.

Efficacy of Early Laparoscopic Surgery in Acute Abdomen Secondary to Perforated Jejunal Diverticulitis

A 39-year-old man with abdominal pain, fever and general poor state. Physical examination showed fever, Tachycardia, Left basal hypoventilation and acute surgical abdomen. A Abdominal X-Ray showed accumulation of calcifications in mesogastric. The laboratory test showed leukocytosis and the abdominal CT-Scan showed the cause of the acute surgical abdomen. The laparoscopic surgery was recommended and performed. A 12-inch angle of Treitz was found perforated diverticulum which was covered with omentum. Forty inches of jejunum including the perforated diverticulum were resected. The patient was discharged from the hospital on the sixth postoperative day. The pathological evaluation revealed a perforated jejunal diverticulum and diverticulosis yeyunal.

A Rare Acute Abdomen Reason: Perforated Jejunal Diverticulitis

A Rare Acute Abdomen Reason: Perforated Jejunal Diverticulitis

Timely Diagnosis of Perforated Jejunal Diverticulitis by Computed Tomography

BackgroundPerforated jejunal diverticulitis is an unusual entity that can present with acute abdominal pain. Due to the non-specific clinical findings, this condition is rarely diagnosed clinically. Case ReportWe present the case of a 75-year-old man in whom a perforated jejunal diverticulitis complicated by abscess formation was diagnosed by computed tomography (CT). He underwent a laparotomy with resection of the involved jejunal segment. He had an uneventful recovery and was subsequently discharged. ConclusionsThis case report demonstrates the utility of CT in accurately diagnosing this unusual entity that frequently perplexes clinicians.

Elderly patient with acute, left lower abdominal pain: perforated jejunal diverticulitis (2010:7b)

An elderly patient with acute, left, lower abdominal pain is described, for whom the diagnosis of perforated jejunal diverticulitis was established by computed tomography (CT). The presence of a jejunal segmental inflammatory process, with or without abscess or perforation, in the setting of jejunal diverticulosis, is very suggestive of jejunal diverticulitis.

Jejunal diverticulitis

A case of perforated jejunal diverticulitis in a 44-yr-old man is described and the literature is reviewed. Jejunal diverticulosis occurs in 0.07% to 2% of the population. Enteroclysis is the best diagnostic test. Diverticulitis with perforation is rare and is associated with high mortality. Treatment is surgical resection of the involved segment. Other complications are bacterial overgrowth, obstruction, and acute hemorrhage. Several theories to explain the physiopathogenesis of the diverticula formation may relate to manometric or histological abnormalities of the small bowel.

Radiologic Findings of Perforated Jejunal Diverticulitis: A Case Report

We report a case of perforated jejunal diverticulitis in a 68-year-old man with iatrogenic Cushing’s syndrome. The patient presented with right upper abdominal pain. Ultrasonography showed a hypoechoic structure connected to a small bowel loop, and subsequent CT examination showed multiple diverticula in proximal jejunal loops with free air trapped within the mesenteric leaf. Segmental resection of the jejunal loop confirmed jejunal diverticulitis with perforation.

Abdominal Wall Abscess Associated with Perforated Jejunal Diverticulitis: Report of a Case

We report a case of abdominal wall abscess caused by diverticulitis of the jejunum penetrating through the abdominal wall. A 53-year-old Japanese woman visited a local hospital complaining of abdominal pain and a mass in the left lower abdomen. An abdominal computed tomography scan showed a tumor with isodensity in the left lower abdominal wall. Magnetic resonance imaging showed a mass in the abdominal wall with isointensity in the T1-intensified image and high intensity in the T2-intensified images. The mass was heterogeneous inside and protruded partially toward the intraperitoneal cavity. Ultrasound examination showed a heteroechoic mass extending into the intraperitoneal cavity. Laparotomy revealed a tumor in the abdominal wall with a fistulous tract extending to the jejunum. We resected the abdominal wall tumor with partial resection of the small intestine. The resected specimen contained a tumor with a fistulous tract passing through the abdominal wall. Histological examination revealed remarkable infiltration of neutrophils and a bacterial mass in the abdominal wall tumor, with a fistulous tract connected to the area adjacent to the mesenteric border of the jejunum. These findings suggested that diverticulitis of the jejunum had penetrated through the abdominal wall, leading to the formation of an abscess. We report this case to highlight the need for complete gastrointestinal evaluation with gastrointestinal barium studies and imaging analysis to examine extension of intra-abdominal lesions in patients with an unexplained abdominal wall abscess.