Diverticulosis Of Small Intestine Research Articles

Perforated Jejunal Diverticulitis: A Rare Cause of Abdominal Pain

Cases of small intestinal diverticulosis are rare and mostly asymptomatic. Occasionally, a small bowel diverticulum may perforate. We describe the case of an 80-year-old male who presented with abdominal pain and signs of localized peritonitis. The ultimate diagnosis was confirmed to be perforated jejunum diverticula. Perforation of the jejunal diverticulum should be considered as part of the differential diagnosis of acute abdomen in elderly patients, and appropriate treatment options, ranging from early surgery to conservative measures, should be tailored to the patient's presenting condition and their overall physiology.

Pyocolecyst in Elderly Patients with Jejunoileal Diverticulosis as a Transoperative Finding. Clinical Case

Introduction: Small intestine diverticulosis is a rare finding, recognized as a cause of non-specific symptoms of the gastrointestinal tract, and however, it is capable of causing life-threatening complications. It frequently occurs in older individuals, as was our case. An incidence between 0.2 to 4.5% is in autopsies reported. Small intestinal diverticula contain only mucosal and submucosal layers, which herniated through the muscular layer and pseudodiverticula classified. Clinical Case: A 95-year-old female with a history of hospitalization one year ago due to cholangitis associated with choledocholithiasis, which ERCP resolved, was discharged for not accepting elective cholecystectomy. She started with epigastric pain 48 hours before hospitalization, accompanied by nausea and vomiting on one occasion of gastro biliary content. Upon questioning, she reported abdominal pain in the right colic frame, present uresis, and no bowel movements. Integrated diagnosis of acute cholecystitis, emergency open cholecystectomy is determined and was done complete cholecystectomy was, later as a finding multiple thin-walled and vascularized diverticula were observed located in the jejunum 70 cm from the angle of Treitz and running towards the ileum, without apparent intestinal distress or perforation, thus concluding the surgical procedure. Discussion: Gallstone disease is a common health problem with an annual incidence of 1 to 4% in the general Western population. For uncomplicated jejunal diverticulosis, the treatment depends on the clinical stadium presentation and its complications, hence the importance of imaging techniques in pre-surgical diagnosis. In uncomplicated jejunal diverticulosis, the treatment is unnecessary; in uncomplicated jejunal diverticulitis, treatment is conservative, with only antibiotics; in perforated diverticulitis, intravenous antibiotic therapy and can be chosen CT-guided drainage and open or laparoscopic surgery is the choice in the case of peritonitis.

S3389 Chronic Diarrhea Caused by Duodenal Diverticulum

Introduction: Diverticula are bulging sacs that can occur in any part of the gastrointestinal tract. While mostly seen in the large intestine, 9–23% of small bowel diverticula are found incidentally via endoscopy. Small intestinal bacterial overgrowth (SIBO) is characterized by an abnormally increased bacterial burden in the small intestine with symptoms including abdominal distension and pain, bloating, and diarrhea. Small intestinal diverticulosis is a known risk factor for SIBO. Small bowel aspirates and culture is considered gold standard for diagnosing SIBO, while aspirates from diverticula is not routine practice for diagnosis. We present a case of SIBO diagnosed by aspirates from a large duodenal diverticulum (DD). Case Description/Methods: A 62-year-old female with chronic diarrhea, hepatic steatosis without cirrhosis, GERD, and diverticulosis presented to the gastroenterology clinic for continued complaints of diarrhea and bloating. The patient noted 4-5 bowel movements per day. Vital signs, physical exam, and previous workup including stool culture, Clostridium difficile study, colonoscopy with biopsies, fecal calprotectin and elastase, abdominal imaging, and celiac serologies were unremarkable. Patient tried pancrelipase with no noticeable difference in diarrhea. An esophagoduodenoscopy (EGD) performed showed multiple fundic gland polyps in the stomach and a large 40 mm diverticula in the 3rd portion of the duodenum. Duodenal and gastric biopsies obtained ruled out celiac disease, pathogens, and Helicobacter pylori. Aspiration of duodenal diverticular fluid was significant for >100,000 colony forming units per mL (CFU/mL) Escherichia coli, Enterococcus faecium, and Streptococcus mitis. Disaccharidases (lactase, sucrase, maltase, palatinase, glucoamylase) were within normal limits. Patient was initiated on rifaximin 550mg TID for 14 days with improvement of her chronic symptoms. (Figure) Discussion: While most DD are asymptomatic, small, and require no treatment, intervention is necessary if the patient develops SIBO, bowel obstruction, diverticulitis, bleeding, or perforation. SIBO can be diagnosed via small bowel aspirates showing >1000 CFU/mL. Large DD can lead to SIBO by creating a protected environment for bacterial species. Treatment of diarrhea due to SIBO and large DDs are treated with antibiotic therapy, like our patient who was prescribed rifaximin and noted improvement of symptoms. It is important to understand that while DD are uncommon, large diverticulum can lead to chronic diarrhea and SIBO.Figure 1.: [A] EGD findings with a large duodenal diverticulum in the upper left corner; [B] Process of aspirating duodenal diverticulum fluid.

CONGENITAL DIVERTICULAR DISEASE OF JEJUNUM PRESENTING AS OBSTRUCTION IN ADULTHOOD: A CASE REPORT FROM LADAKH

Of the many causes of small bowel obstruction, volvulus of the midgut is seen mainly in paediatric age group only, along with malrotation of the gut. However, the volvulus of the small gut in an adult is rare. Volvulus of the midgut in adulthood could be due to many reasons like long mesentery, adhesive bands, internal herniation, endometrioses, etc. But volvulus occurring due to diverticulosis of small intestine is a rare occurrence. The diverticulosis in most of the adult patient are acquired (pulsion diverticuli) with a diverticular wall having only two layers of the intestine. Congenital diverticulosis with the diverticuli bearing all the layers of the intestine leading to the volvulus of the midgut makes it still rarer. We present the case of midgut volvulus arising due to congenital true jejunal diverticulosis in a 50-years-old adult along with a brief review of the literature. In our case report, volvulus occurred in an adult due to congenital diverticulosis of jejunum making it a difficult preoperative diagnosis and a rare case reporting.

A Rare Case of Neonatal Extensive Small Intestinal Diverticulosis Associated with Jejunal Atresia.

A Rare Case of Neonatal Extensive Small Intestinal Diverticulosis Associated with Jejunal Atresia.

Small Bowel Diverticulosis: Does Location Matter?

Small intestinal diverticulosis is characterized by the presence of multiple sac-like mucosal herniations through weak points in the intestinal wall which are far less common than colonic diverticula. Terminal ileal diverticulosis is extremely rare with a reported prevalence on conventional barium studies of 0.3-1.9%. They are most commonly observed in the duodenum (45%) followed by the jejunum (16%) and ileum (5%). We report a case of an 82 year old male with a history of hypertension, diabetes mellitus, coronary artery disease, heart failure, and cerebrovascular accident who was admitted for shortness of breath secondary to symptomatic anemia. He was found to have a microcytic anemia and dark stools with no signs of active bleeding. An esophagogastroduodenoscopy (EGD) was grossly unremarkable and biopsies revealed mild, chronic, inactive gastritis that was negative for Helicobacter pylori and intestinal metaplasia. A colonoscopy revealed severe diverticulosis throughout the entire colon as well as the terminal ileum without signs of active or recent bleeding (figure 1). Although no active bleeding was seen on ileo-colonoscopy it was presumed that the source of bleeding was either from an ileal or colonic diverticular bleed. The patient was conservatively managed and remained hemodynamically stable with no further episodes of black stools and was subsequently discharged home. Small bowel diverticulosis is a rare clinical entity. Most cases are diagnosed incidentally upon abdominal computed tomography (CT) or endoscopy. However, Gross and Katz (2003) recommend that any patient with a triad of anemia, abdominal pain, and an abdominal radiograph with dilated loops of small bowel merits small bowel diverticulosis in the differential diagnosis [4]. Furthermore, clinicians should be aware that small bowel diverticulosis can be associated with complications such as pseudo-obstruction, blind loop syndrome, dyskinesia, chronic diverticulitis, enterolith, perforation, peritonitis, bleeding, fistula formation, volvulus, and malabsorptive diarrhea [2-5]. Since gastrointestinal bleeding is a known complication of small intestinal diverticulosis, terminal ileum intubation at time of colonoscopy should always be performed especially if an upper endoscopy and colonoscopy fail to identify a source of bleeding and in the appropriate clinical context.2531 Figure 1. Diverticulosis in the terminal ileum.

Modern opportunities of radiation diagnostics of small intestine diverticulosis

Diverticulosis of distal parts of a small intestine is a rare and difficultly diagnosed disease. This pathology usually is asymptomatic, and the first clinical manifestations oftenly testify the development of complications. The leading seat in the diagnosis of diverticulosis is borrowed with beam investigative techniques: ultrasonography, barium enterography, CT or MRI. In this article a brief review of clinics and possibilities of instrumental diagnosis of diverticulosis of small intestine is presented and illustrated by clinical case of a patient with large jejunoileal diverticulosis.

腹部造影CTが診断処置に有用であった小腸憩室出血の1例

腹部造影CTが診断処置に有用であった小腸憩室出血の1例

English

Diverticulosis of small intestine is an uncommon disease, with variable clinical presentation. Among the small bowel diverticulae, distal jejunal diverticulae form the most common subset. Diverticulosis of proximal jejunum represents an uncommon pathology of the small bowel. The condition is usually asymptomatic and should be taken into consideration in cases of unexplained malabsorption, anemia, chronic abdominal pain or discomfort. Complications such as diverticulitis, perforation, bleeding or intestinal obstruction appear in 10-30% of the patients increasing morbidity and mortality rates. We herein report a case of a 45 year-old man, who presented at the emergency department with acute abdominal pain, vomiting and abdominal distension. Preoperative radiological examination followed by laparotomy revealed multiple proximal jejunal diverticulae, filled with food, adherent to and compressing upon the terminal ileum, causing intestinal obstruction.

消化管超音波検査が術前診断に有用であった小腸憩室炎の1例

消化管超音波検査が術前診断に有用であった小腸憩室炎の1例

回腸憩室穿通により緊急手術を要した小腸多発憩室症の1例

症例は63歳，男性．来院3日前からの持続する右側腹部痛で当院受診した．腹部造影CT検査にて回盲部に膿瘍形成と腸管外ガス像を認めたため，汎発性腹膜炎と診断し緊急開腹手術を行った．腹腔内は膿性腹水が貯留し，回腸末端から上行結腸に膿瘍形成を認めたため回盲部切除を行った．さらにTreitz靱帯より10cmから70cmの空腸に9個の巨大憩室を認めたが，感染徴候はなくそのまま経過観察とした．摘出標本を確認すると，憩室は回腸末端部のみに多数存在し，そのうちの1つが穿通し回腸腸間膜側に膿瘍形成していた．病理組織検査で真性憩室穿通による腸間膜膿瘍と診断した．術後の経過は良好であり術後13日目に退院となった．回腸憩室穿通/穿孔は，回腸末端に多いとする報告が散見されるが，自験例も含めて診断に難渋することが多い．しかし穿孔例は重篤な転帰となる報告もあるため，疑わしい症例は早期より手術も肝要と考えられた．

Perfuração de intestino delgado por doença diverticular jejunal

Small Intestine's diverticulosis is an uncommon pathology of intestine. It's more evident at jejune and can be complicated by intestinal perforation, obstruction or diverticulitis, increasing the mortality. We describe a forty years old female patient that arrived at emergency service complained of diffuse abdominal pain. There aren't signals of peritonitis and the radiological evaluation showed small intestine's distension. Surgical intervention was performed revealing multiples diverticulums at jejune and intestinal perforation. The aim of this article is present a case of Small Intestine's diverticulosis and its complications that had precise intervention resulting in a favorable resolution.

Therapieresistente periprothetische Abszedierung der Hüfte unklarer Ursache

Two months after total endoprosthesis of the hip (Spotorno) a 60-year-old obese female patient complained about increasing hip pain. Costly diagnostic measures could not clarify the cause. Analgesic therapy administered with local cortisone injections was not satisfactory. Upon deterioration of her general condition the patient was hospitalized. A periprosthetic abscess of the hip with atypical muscle necrosis could not be controlled after several interventions. Computed tomography of the abdomen and hip revealed a jejunoacetabular fistula after mesenteric perforation with small intestine diverticulosis. It seems to be the first published case. After abdominal and hip surgery the further course was good. There was no need to replace the prosthesis. Retroperitoneal abscess with purely coxal symptomatology has been described. Diverticulitis of the small intestine has a poor prognosis. When infections with unusual necrosis resistant to therapy after hip prosthesis surgery occur, consideration must be given to retroperitoneal abscess. Abdominal tomography allows the life-saving surgery.

Mitochondrial Neurogastrointestinal Encephalomyopathy: Evidence of Mitochondrial DNA Depletion in the Small Intestine

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an autosomal recessive disease clinically defined by gastrointestinal dysmotility, cachexia, ptosis, ophthalmoparesis, peripheral neuropathy, white-matter changes in brain magnetic resonance imaging, and mitochondrial abnormalities. Loss-of-function mutations in thymidine phosphorylase gene induce pathologic accumulations of thymidine and deoxyuridine that in turn cause mitochondrial DNA (mtDNA) defects (depletion, multiple deletions, and point mutations). Our study is aimed to define the molecular basis of gastrointestinal dysmotility in a case of MNGIE. By using laser capture microdissection techniques, we correlated histologic features with mtDNA abnormalities in different tissue components of the gastrointestinal wall in a MNGIE patient and ten controls. The patient's small intestine showed marked atrophy and mitochondrial proliferation of the external layer of muscularis propria. Genetic analysis revealed selective depletion of mtDNA in the small intestine compared with esophagus, stomach, and colon, and microdissection analysis revealed that mtDNA depletion was confined to the external layer of muscularis propria. Multiple deletions were detected in the upper esophagus and skeletal muscle. Site-specific somatic point mutations were detected only at low abundance both in the muscle and nervous tissue of the gastrointestinal tract. Analysis of the gastrointestinal tract from 10 controls revealed a non-homogeneous distribution of mtDNA content; the small intestine had the lowest levels of mtDNA. Atrophy, mitochondrial proliferation, and mtDNA depletion in the external layer of muscularis propria of small intestine indicate that visceral myopathy is responsible for gastrointestinal dysmotility in this MNGIE patient.

Gastrointestinal Stromal Tumors

Familial gastrointestinal stromal tumor (GIST) is a rare autosomal dominant genetic disorder. We report the second family to date with a germline point mutation in exon 17 of the KIT gene that leads to substitution of aspartic acid at position 820 with tyrosine (D820Y). One or more GISTs was documented in three generations of this kindred, and there was associated hyperplasia of the interstitial cells of Cajal (ICC). One affected family member complained of dysphagia and another suffered small intestinal diverticulosis with perforation, which may represent additional consequences of ICC hyperplasia. Diffuse and nodular ICC hyperplasia associated with the latter family member's small intestinal diverticulosis is illustrated, providing supportive functional and morphologic evidence for the ICC being the cell of origin of GISTs. Skin hyperpigmentation was not observed. Analysis of a 17-cm malignant GIST in the index patient revealed that it was hemi/homozygous for the germline D820Y mutation, indicating loss of the remaining wild-type KIT allele with tumor progression. Two smaller lesions from this patient were heterozygous for the mutation. This phenomenon has been observed in up to 8% of sporadic malignant GISTs but has not been documented in familial disease.

Small Intestinal Diverticulosis (SID)

Small intestinal diverticulosis (SID) refers to the clinical entity characterized by the presence of multiple saclike mucosal herniations through weak points in the intestinal wall. Small intestinal diverticula are far less common than colonic diverticula. The cause of this condition is not known. It is believed to develop as the result of abnormalities in peristalsis, intestinal dyskinesis, and high segmental intraluminal pressures. CASE REPORT A 82-year-old women presented with a history of chronic abdominal discomfort and dyspepsia. She was diagnosed as having malabsorption syndrome and was treated with broadspectrum enteral antibiotics. She had a symptom free period. Contrast examination was carried out (Figures 1 and 2). Figure 1 Figure 1: Barium meal follow through shows out pouching of the bowel wall – diverticuli in the jejunal loops (supine film). Figure 2 Figure 2: Another film from the series (erect film) clearly demonstrates the diverticuli. QUESTIONS What is this examination and how is it done? 1. What is the diagnosis? 2. What are the complications? 3. How do you treat this condition? 4. ANSWERS This is a barium meal follow through examination 1. where diluted barium contrast is given to the patient to drink (300 ml) and as it passess through the stomach and duodenum in to the small bowel Small Intestinal Diverticulosis (SID) 2 of 3 (jejunum and Ileum) series of films are taken. This examination is mainly intended for the visualisation of small bowel. The diagnosis is jejunal diverticulosis. 2. Complications – see below in discussion. 3. Treatment – see below in discussion. 4. DISCUSSION The incidence of small bowel diverticulosis is difficult to ascertain for several reasons. It is likely that many clinicians do not document the presence of these lesions simply because little clinical significance has been attributed to them. Their importance is based on the fact that they carry the risk of serious complications such as infection, hemorrhage or intestinal obstruction The predominance of small bowel diverticula in the jejunum is attributed to the greater diameter of the penetrating jejunal arteries [8]. The jejunal diverticula emerge on the mesenteric border, i.e., sites where mesenteric vessels penetrate the small bowel. Diverticula are classified as true and false. True diverticula are composed of all layers of the intestinal wall, whereas false diverticula are formed from the herniation of the mucosal and submucosal layers. Meckel’s diverticulum is a true diverticulum. Diverticula can also be classified as intraluminal or extraluminal. Intraluminal diverticula and Meckel’s diverticulum are congenital. Extraluminal diverticula may be found in various anatomic locations and are referred to as duodenal, jejunal, ileal, or jejunoileal diverticula. With the exception of Meckel diverticulum, small bowel diverticula are generally benign, seldom creating serious complications. Major complications include diverticulitis, GI hemorrhage, intestinal obstruction, acute perforation, and pancreatic and/or biliary disease in duodenal diverticula. Mortality is influenced by patients' age, nature of complications, and timeliness of intervention. No racial predilection exists. A slight male preponderance exists in jejunoileal diverticula. Jejunoileal diverticula are commonly observed in patients aged 60-70 years. Reports of this condition in young adults exist as well. Their importance is based on the fact that they carry the risk of serious complications. Complications occur in 15% of SBD cases. The specific diagnosis of SID is possible by radiologic contrast studies using various forms of barium. The radiologic technique of enteroclysis is specific for the jejunum and the ileum. Lesions bleeding at the time of investigation can be identified either by a 99m Tc-bleeding scan, or by arteriography if blood loss is greater than 1±2 l/minute. TREATMENT Asymptomatic no treatment Small bowel diverticula do not require surgical treatment unless refractory symptoms or complications occur. Surgical management is recommended for complications of SBD. When complications of jejunal diverticula occur, partial enterectomy and primary anastomosis should be performed . It is reasonable to conclude that asymptomatic diverticula incidentally discovered on routine contrast studies or at laparotomy do not need resection.

DIVERTICULOSIS OF THE SMALL INTESTINE AND MEGALOBLASTIC ANEMIA

Abstract. Megaloblastic anemia and small intestinal diverticulosis in a 79‐year‐old woman are reported. Laboratory studies showed normal secretion of intrinsic factor and that the anemia was due to defective absorption of vitamin B12. The bacterial concentration in duodenal fluid was 3,400,000 E. coli per ml. In vitro the bacteria had a high uptake of “free” 57CoB12 and a low uptake of 57Co bound to intrinsic factor. This supports the theory that small intestine bacteria cause vitamin B12 malabsorption by inhibitory action on the absorptive epithelium.

Diverticulosis of the small intestine. Clinical, bacteriologic, and metabolic observations in a group of seven patients.

Seven patients with small-intestinal diverticulosis were studied by means of intestinal absorptive tests, biopsies, and bacterial cultures of small-intestinal aspirates. Aerobic bacterial cultures were obtained in all patients, while anaerobic cultures with a modified Hungate roll-tube technic were performed in 3. Three of the patients manifested steatorrhea and were studied over prolonged periods of time. The bacterial flora varied over a wide quantitative range, with highest total counts in excess of 109 colony-forming units per milliliter found in the 2 patients with the most severe malabsorption. Despite multiple diverticulosis, 1 patient without steatorrhea had no recoverable aerobic or anaerobic bacterial flora. E. coli predominated among the recovered aerobic organisms in this series, but A. aerogenes and various streptococci also were encountered repeatedly. Patients treated with antibiotics directed at the aerobic flora showed prompt improvement in absorption, and reduction in bacterial counts. Repeated short courses of antibiotics were needed to treat early bacteriologic and clinical relapses. After several such courses, all 3 patients treated maintained their clinical and metabolic improvement for periods of close observation ranging from 2 to 15 months without additional antibiotic treatment, and the clinical remissions were accompanied by gradual reductions in total bacterial counts to “borderline normal” limits. Of the 3 patients, 1 has now been followed for 5 years without relapse. It is apparent that the mere presence of diverticulosis does not lead necessarily to malabsorption. Malabsorption of fat, Vitamin B12, and other nutrients was found only in patients with excessive bacterial flora, emphasizing the crucial role bacteria play in the pathogenesis of malabsorption in diverticulosis of the small intestine.

Idiopathic Fistula Formation in the Gastrointestinal Tract

Summary A patient is reported with severe malabsorption and inanition due to multiple fistulous tracts between the small bowel and colon and between adjacent loops of small bowel. Jejunal diverticulosis and idiopathic obliteration of the peritoneal cavity by old adhesions were also present. Only two other similar cases have been found in a review of the literature. The etiology of the fistulous tracts in these patients is unknown. However, in view of the dense adhesions and marked obliteration of the peritoneal cavity it is possible that the fistulas developed between the closely bound loops of bowel, possibly through inflamed diverticula. This unusual malabsorption syndrome should be suspected in patients presenting with the following findings: 1) rapid intestinal transit of food or barium in the absence of a past history of intra-abdominal disease; 2) normal small bowel mucosal pattern by x-ray and essentially normal biopsy; and 3) small intestinal diverticulosis. Although the fistulous tracts may fail to visualize on radiological examination of the upper GI tract, they should be readily demonstrable by barium enema.

Mimetic aspects of small intestinal diverticulosis. A report of four cases.

Introduction Of the various diverticula arising in the gastrointestinal tract, those occurring in the jejunum have seldom stimulated great clinical interest. Typically asymptomatic, jejunal diverticula give rise only rarely to nonspecific complications such as perforation and hemorrhage. However, as is now established, jejunal diverticula have the unique potentiality of simulating certain clinical syndromes. The association of such diverticula with megaloblastic anemia and malabsorption has enlarged the differential diagnosis and the clinical management of these conditions. Since 1949, twenty-five cases of jejunal diverticulosis, megaloblastic anemia, and/or intestinal malabsorption have been reported, * reflecting both the infrequency and the increasing recognition of the syndrome. 4-21 Jejunal diverticulosis, invariably present, has frequently been associated with other intestinal diverticula. Of these cases the predominant finding was anemia or defective absorption of Vitamin B 12 in 9, steatorrhea in 3, and combinations of these abnormalities in the remainder. The bone marrow was megaloblastic in 16 of