Jejunal diverticulosis: A case report.

INTRODUCTION: Jejunal diverticulosis is a rare entity that presents a challenging diagnosis due to its vague and non-specific clinical presentations. 40 % of the patients remain asymptomatic until the development of complications. CASE PRESENTATION: We report a case of 84 years old female who presented to the hospital with vomiting and abdominal pain, found to have jejunal diverticulosis complicated by perforation in a CT scan. The patient underwent emergency expletory laparotomy with segmental intestinal resection and anastomosis. DISCUSSION: The incidence of jejunal diverticulosis ranges between 3 and 5 %, with most patients discovered incidentally. Therefore, medical or surgical treatment management depends on clinical presentation and complications that necessitate surgical intervention. CONCLUSION: Jejunal diverticulosis is a rare entity that commonly affects the elderly with significant morbidity and mortality; it is an important clinical entity to consider when approaching patients with acute abdomen.

Acute Perforated Appendicitis Associated with Appendiceal Diverticulitis in a Young Man: A Case Report with Literature Review.

BACKGROUND Diverticulosis of the vermiform appendix is rare. In patients who present with appendicitis, appendiceal diverticulitis as a cause due is also rare. We report the case of a 35-year-old man who presented with typical symptoms and signs of acute appendicitis, which was confirmed by histopathology to be due to perforated acute appendiceal diverticulitis. CASE REPORT A 35-year-old man presented to our Emergency Department with a 1-day history of right lower-quadrant abdominal pain that radiated to the left lower quadrant, which was associated with fever, vomiting, and abdominal distention. Biochemical analysis revealed mild leukocytosis. Computed tomography (CT) revealed signs of acute perforated appendicitis and early mass formation. The patient underwent laparoscopic appendectomy. Histopathological examination revealed appendiceal diverticulitis (pseudo-diverticulum). CONCLUSIONS Appendiceal diverticulitis is a rare surgical entity and is often an overlooked diagnosis. The differential diagnosis of appendiceal diverticulitis in patients presenting with signs of acute appendicitis is important as it is associated with a higher rate of complications such as perforation and an increased risk of appendiceal neoplasms. Appendectomy is a safe and appropriate treatment for appendiceal diverticulitis.

Laparoscopic Double-Tract Esophago-Jejunostomy Reconstruction for Iatrogenic Esophageal Perforation After Endoscopic Pneumatic Dilatation for Achalasia: A Case Report.

BACKGROUND Achalasia is a rare primary esophageal motility disorder of unknown etiology, with significant negative impact on patient quality of life. Esophageal perforation is the most serious complication after pneumatic dilatation for achalasia, with a high mortality rate of up to 20%. Double-tract reconstruction is used mainly after proximal gastrectomy for gastric cancer, with the advantage of functional preservation of the stomach. We report a case of iatrogenic esophageal perforation after endoscopic pneumatic dilatation for achalasia that was successfully managed by laparoscopic proximal gastrectomy with double-tract reconstruction. CASE REPORT An elderly man started to manifest desaturation during endoscopic dilatation for achalasia, and multiple esophageal perforations were confirmed just above the gastroesophageal junction. During diagnostic laparoscopy, multiple perforations were found 2 cm proximal to the gastroesophageal junction extending 5 cm proximally with multiple linear mucosal tears. A trial of primary repair was difficult and double-tract reconstruction was performed by transection of the distal esophagus above the perforations and proximal gastrectomy. Then, 3 anastomoses were performed: end-to-end esophago-jejunostomy, end-to-side jejuno-jejunostomy, and side-to-side gastro-jejunostomy 15 cm distal to the esophago-jejunostomy site. After a smooth postoperative course, he was discharged home and was followed up regularly. CONCLUSIONS Esophageal perforation is the most serious complication after endoscopic pneumatic dilatation for achalasia. Double-tract reconstruction is a feasible and effective reconstruction modality following esophageal resection that avoids complications of esophago-gastrostomy. This technique deserves to be considered a valid treatment modality for advanced and complicated cases of achalasia, but further research is needed.

Laparoscopic management for gallstone ileus, case report.

INTRODUCTION: Gallstone ileus is a rare complication of cholelithiasis leading to small intestinal obstruction. Elderly females are commonly affected more than male. The diagnosis of this condition is challenging and Rigler's triad is pathognomonic. Surgery is mandatory with no clear consensus about the best surgical approach that should be adopted. CASE PRESENTATION: An elderly female patient, with no previous history of biliary diseases, presented with small bowel obstruction. Contrast enhanced computed tomography of the abdomen showed the classical Rigler's triad. Total laparoscopic enterolithotomy was performed successfully. She had smooth postoperative course and she was followed up regularly without occurrence of any biliary disease symptoms during the follow up period. CONCLUSION: Gallstone ileus should be considered in differential diagnosis of small bowel obstruction mainly in old females with no previous history of abdominal surgery. Laparoscopic enterolithotomy is safe, feasible and effective when performed by experienced surgeons.