RESUMO
BACKGROUND Jejunal diverticulosis are false diverticula of the small bowel that form from outpouching of the mucosa and submucosa. They are pulsion diverticula that are often asymptomatic and can be found incidentally during surgery. In some instances, jejunal diverticula could result in intestinal obstruction. Small intestinal volvulus is an uncommon cause of small bowel obstruction that results in a closed loop obstruction and is an indication for emergent surgical intervention. CASE REPORT We report a case of an 84-year-old man who presented to the Emergency Department with abdominal pain and generalized weakness. A preoperative computerized tomographic scan demonstrated a closed loop small bowel obstruction with mesenteric swirling. The patient was taken for a diagnostic laparoscopy, which revealed extensive proximal jejunal diverticulosis and a volvulus of the involved jejunum. An exploratory laparotomy was warranted for safe detorsion of the small bowel and resection of the diseased segment. The small bowel was successfully detorsed, with resection of the involved jejunum. Intestinal continuity was established by a primary side-to-side anastomosis. CONCLUSIONS Jejunal diverticula have been reported in the literature as a cause of small bowel obstructions, and very few reports exist of concurrent small bowel volvulus. In very rare instances, both of these conditions can coexist. There should be prompt surgical intervention in all cases of closed loop small bowel obstructions to prevent intestinal ischemia, perforation, and sepsis.
Assuntos
Divertículo , Obstrução Intestinal , Volvo Intestinal , Intestino Delgado , Doenças do Jejuno , Idoso de 80 Anos ou mais , Humanos , Masculino , Divertículo/complicações , Divertículo/cirurgia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Volvo Intestinal/etiologia , Volvo Intestinal/cirurgia , Intestino Delgado/anormalidades , Doenças do Jejuno/cirurgia , Doenças do Jejuno/complicações , Doenças do Jejuno/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
A jejunal diverticular haemorrhage is the second most common complication of jejunum diverticula. It can manifest clinically as acute upper gastrointestinal bleeding and is common to imitate acute rectal bleeding. Bleeding is usually associated with or without haemodynamic stability. Its diagnosis is challenging, requiring imaging examinations. Treatment is conservative management or surgery.
Assuntos
Divertículo , Hemorragia Gastrointestinal , Doenças do Jejuno , Humanos , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Doenças do Jejuno/diagnóstico , Doenças do Jejuno/complicações , Doenças do Jejuno/cirurgia , Divertículo/complicações , Divertículo/diagnóstico , Divertículo/diagnóstico por imagem , Masculino , Idoso , Feminino , Tomografia Computadorizada por Raios X , Diagnóstico DiferencialRESUMO
Jejunal diverticula, like other intestinal diverticula, can become complicated and present as acute abdomen. Diagnosis is difficult and management in complicated cases can be surgical as well as conservative. We present two cases of complicated jejunal diverticulosis that presented with acute abdomen and were managed surgically. Post-operative recovery was satisfactory. Jejunal diverticula is a diagnostic challenge in a low-resource peripheral hospital.
Assuntos
Abdome Agudo , Divertículo , Doenças do Jejuno , Humanos , Doenças do Jejuno/complicações , Doenças do Jejuno/diagnóstico , Doenças do Jejuno/cirurgia , Divertículo/complicações , Divertículo/diagnóstico , Divertículo/cirurgia , Jejuno/cirurgia , Hospitais de EnsinoRESUMO
BACKGROUND: Small intestine diverticula are rare findings that were mostly reported in the elderly population as asymptomatic findings. However, they can also present with a wide range of symptoms (bloating, early satiety, chronic abdominal discomfort, and diarrhea/steatorrhea) or complications (gastrointestinal bleeding, small bowel obstruction, acute diverticulitis, or perforation) which in turn warrant medical treatment or urgent surgical intervention. CASE PRESENTATION: This is a case report of an 84-year-old female who presented with an acute surgical abdomen. An exploratory laparotomy revealed complicated small bowel diverticula with a jejunal diverticulum perforation, for which a diverticulectomy was performed. CONCLUSIONS: Throughout this paper, we are aiming to outweigh the consideration of the possibility of complicated small bowel diverticula as a differential in the evaluation of any acute abdomen, especially in the elderly, which warrants emergency surgical management.
Assuntos
Diverticulite , Divertículo , Perfuração Intestinal , Doenças do Jejuno , Idoso , Idoso de 80 Anos ou mais , Diverticulite/complicações , Diverticulite/diagnóstico , Diverticulite/cirurgia , Divertículo/complicações , Divertículo/diagnóstico , Divertículo/cirurgia , Feminino , Humanos , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Intestino Delgado/cirurgia , Doenças do Jejuno/complicações , Doenças do Jejuno/diagnósticoAssuntos
Doenças do Jejuno , Malformações Vasculares , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Humanos , Doenças do Jejuno/complicações , Doenças do Jejuno/diagnóstico , Doenças do Jejuno/cirurgia , Jejuno/cirurgia , Malformações Vasculares/complicações , Malformações Vasculares/diagnósticoAssuntos
Coristoma , Divertículo , Doenças do Jejuno , Coristoma/complicações , Coristoma/cirurgia , Divertículo/complicações , Divertículo/diagnóstico por imagem , Divertículo/cirurgia , Humanos , Doenças do Jejuno/complicações , Doenças do Jejuno/diagnóstico por imagem , Doenças do Jejuno/cirurgia , PâncreasAssuntos
Divertículo , Doenças do Jejuno , Divertículo/complicações , Divertículo/diagnóstico , Divertículo/cirurgia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Humanos , Doenças do Jejuno/complicações , Doenças do Jejuno/diagnóstico , Jejuno/cirurgiaAssuntos
Humanos , Feminino , Idoso , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico , Divertículo/complicações , Divertículo/diagnóstico , Doenças do Jejuno/complicações , Doenças do Jejuno/diagnóstico , Malformações Arteriovenosas/cirurgia , Tomografia Computadorizada por Raios X , Divertículo/cirurgia , Hemorragia Gastrointestinal/etiologia , Doenças do Jejuno/cirurgia , LaparotomiaRESUMO
Small bowel diverticulosis is rare. False diverticula form in the jejunum, and less commonly, the ileum. As with their large bowel counterparts, these diverticula provide a pocket for stasis of bowel content, leading to the formation of enteroliths. This case report highlights two complications from jejunal diverticulosis: jejunal diverticulitis and a small bowel obstruction as a result of enterolithiasis; the latter being a rare entity which should be a differential diagnosis for any individual presenting with gastrointestinal obstructive symptoms and radiological evidence of small bowel diverticulosis.
Assuntos
Diverticulite , Divertículo , Íleus , Doenças do Jejuno , Diverticulite/complicações , Diverticulite/diagnóstico por imagem , Diverticulite/cirurgia , Divertículo/complicações , Divertículo/diagnóstico por imagem , Divertículo/cirurgia , Humanos , Íleus/diagnóstico por imagem , Íleus/etiologia , Íleus/cirurgia , Doenças do Jejuno/complicações , Doenças do Jejuno/diagnóstico por imagem , Jejuno/diagnóstico por imagem , Jejuno/cirurgiaRESUMO
Background: Jejunal diverticulosis and jejunal lipomatosis are uncommon conditions. Usually asymptomatic, they may cause severe complications in some cases. Intussusception is unusual in adults, but when diagnosed swiftly it can be treated surgically, usually with good outcome. Case presentation: We present a 60-year-old female patient with a history of chronic malnutrition and anemia, complaining of acute abdominal pain, vomiting and diarrhea. Contrast-enhanced abdominal computed tomography (CT) showed intussusception, multiple giant jejunal diverticula and multiple lipomas. The patient underwent urgent surgery, but radical treatment was not possible due to the extent of the diseases. One month later, another surgery was needed due to ileostomy obstruction caused by lipomas. The patient's condition deteriorated due to malnutrition and concomitant metabolic disorders, which eventually led to her demise. Conclusions: Radical treatment is not always possible in an extensive jejunal disease. Prolonged malnutrition impairs postoperative healing, and therefore surgical or nutritional treatment should be considered in jejunal diverticulosis before the onset of severe complications requiring urgent surgical intervention.
Assuntos
Divertículo , Intussuscepção , Doenças do Jejuno , Divertículo/complicações , Divertículo/diagnóstico por imagem , Divertículo/cirurgia , Feminino , Humanos , Intestino Delgado , Intussuscepção/diagnóstico , Intussuscepção/diagnóstico por imagem , Doenças do Jejuno/complicações , Doenças do Jejuno/diagnóstico por imagem , Jejuno/cirurgia , Pessoa de Meia-IdadeAssuntos
Abdome Agudo/etiologia , Diverticulite/complicações , Perfuração Intestinal/complicações , Doenças do Jejuno/complicações , Doenças Raras/complicações , Idoso , Diverticulite/cirurgia , Feminino , Humanos , Perfuração Intestinal/cirurgia , Doenças do Jejuno/cirurgia , Doenças Raras/cirurgiaRESUMO
BACKGROUND: Angiodysplasia of the gastrointestinal tract is a rare vascular pathology that sometimes causes massive hemorrhage. Angiodysplasias are particularly difficult to find in the small intestine for anatomical reasons, often impeding their diagnosis and treatment. Lesion localization is a major challenge in cases of small bowel bleeding requiring surgical intervention. CASE PRESENTATION: The present case was a 52-year-old woman who was urgently hospitalized with repeated tarry stools. Surgical intervention was chosen after conservative treatment failed to improve her condition. The source of bleeding was suspected to be a vascular lesion discovered in the small intestine during a past double-balloon endoscopy. Abdominal contrast computed tomography revealed a jejunal hemorrhage. We chose selective arterial embolization to stabilize her hemodynamics followed by surgical intervention as her treatment plan. Several embolic and contrast agents (cyanoacrylate, indigo carmine, and Lipiodol) were combined to help identify the location of the lesion during surgery. This multi-pronged approach allowed us to localize the lesion under laparoscopic guidance with high confidence and accuracy, and to excise a 6-cm segment of the small intestine. The lesion was histologically diagnosed as angiodysplasia. No re-bleeding has been observed since the operation. CONCLUSION: We report our experience with a case of jejunal angiodysplasia, which was localized with selective arterial embolization using an array of embolic and contrast agents, and then excised laparoscopically. Selective arterial embolization with indigo carmine dye to treat small bowel bleeding preoperatively not only makes the surgery safer by stabilizing the patient's hemodynamics, but is also very useful for localizing the lesion intraoperatively.
Assuntos
Angiodisplasia , Embolização Terapêutica , Doenças do Jejuno , Laparoscopia , Angiodisplasia/complicações , Angiodisplasia/cirurgia , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Humanos , Doenças do Jejuno/complicações , Doenças do Jejuno/cirurgia , Jejuno/irrigação sanguínea , Jejuno/cirurgia , Pessoa de Meia-IdadeRESUMO
A patient with a history of multiple jejunal diverticulosis (JD) presented with a non-peritonitic abdominal pain and leucocytosis. CT scan showed a thick-walled interloop collection within the left mid-abdomen with dilated bowels and mild diffuse air-fluid levels. Exploratory laparotomy revealed multiple diverticular outpouchings in the mid-jejunum, one of which was perforated, contained within the mesentery. Resection of the contained abscess and primary anastomosis were performed subsequently.
Assuntos
Dor Abdominal/etiologia , Abscesso/diagnóstico , Diverticulite/diagnóstico , Perfuração Intestinal/diagnóstico , Doenças do Jejuno/diagnóstico , Doenças Peritoneais/diagnóstico , Abscesso/etiologia , Abscesso/terapia , Administração Intravenosa , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Conversão para Cirurgia Aberta , Diverticulite/complicações , Diverticulite/terapia , Feminino , Humanos , Perfuração Intestinal/etiologia , Perfuração Intestinal/terapia , Doenças do Jejuno/complicações , Doenças do Jejuno/terapia , Jejuno/diagnóstico por imagem , Jejuno/cirurgia , Laparoscopia , Doenças Peritoneais/etiologia , Doenças Peritoneais/terapia , Tomografia Computadorizada por Raios XRESUMO
CASE: We present a case of azole and partial caspofungin-resistant Candida albicans spondylodiscitis, after bariatric surgery with bowel perforation. Treatment included debridement and several months of anidulafungin, complemented with antibacterial therapy because of relapse for bacterial superinfection. After treatment, the infection did not recur clinically or radiologically during one and half years follow-up. CONCLUSION: Although C. albicans spondylodiscitis is rare, fungi should be suspected as a causative agent. Adequate history, imaging and laboratory testing, and medical and surgical treatment should be performed to successfully eradicate the infection and resolve potential neurological deficits.
Assuntos
Cirurgia Bariátrica/efeitos adversos , Candida albicans/fisiologia , Discite/microbiologia , Farmacorresistência Fúngica Múltipla , Complicações Pós-Operatórias/microbiologia , Idoso , Anti-Infecciosos/uso terapêutico , Candida albicans/isolamento & purificação , Candidíase/complicações , Farmacorresistência Bacteriana Múltipla , Feminino , Humanos , Perfuração Intestinal/complicações , Doenças do Jejuno/complicações , Choque Séptico/tratamento farmacológico , Choque Séptico/etiologia , Fraturas da Coluna Vertebral/microbiologia , Fraturas da Coluna Vertebral/cirurgiaRESUMO
INTRODUCTION: Small bowel diverticulosis (SBD) is a rare entity. Although it is usually an asymptomatic condition, clinical manifestations may vary from non-specific clinical signs to severe and complicated disease. The coexistence of SBD and Crohn's disease (CD) is rarely reported in the current literature. AIM: We present a rare case of concomitant Crohn's disease (CD) and SBD in a male patient, where multiple jejunal diverticula were an incidental intraoperative finding. Preoperative evaluation with magnetic resonance enterography (MRE) failed to recognize the coexistence of these two entities. Surgeons should be aware of the possibility of this rare situation. CASE REPORT: A 52-year-old Caucasian male diagnosed with CD was referred to our department for surgical intervention due to an ileal stricture. The patient reported no past medical history, except for a few episodes of bloody diarrhoea during a three-year period. The index colonoscopy revealed luminal narrowing in the ileum at approximately 70 cm proximal to the ileocaecal valve, and biopsies revealed findings compatible with CD. Clinical examination and laboratory tests were unremarkable one day before surgery. The patient underwent laparoscopic segmental resection of the affected part of the ileum. Intraoperatively, multiple non-inflamed diverticula along the jejunum extending from the Treitz ligament to the proximal ileum were recognized. Our patient had an uncomplicated post-operative course and was discharged on the fifth post-operative day. Pathological examination revealed features compatible with CD in the active phase. The patient was referred to his gastroenterological team for further consultation regarding the appropriate post-operative management. CONCLUSION: Concomitant CD and SBD is a rare condition, and the differential diagnosis may be challenging due to overlapping symptoms.
Assuntos
Doença de Crohn/cirurgia , Divertículo/diagnóstico , Doenças do Íleo/cirurgia , Achados Incidentais , Intestino Delgado/anormalidades , Doenças do Jejuno/diagnóstico , Constrição Patológica , Doença de Crohn/complicações , Doença de Crohn/diagnóstico por imagem , Divertículo/complicações , Humanos , Doenças do Íleo/complicações , Doenças do Íleo/diagnóstico por imagem , Doenças do Jejuno/complicações , Laparoscopia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeAssuntos
Divertículo/diagnóstico , Doenças do Jejuno/diagnóstico , Mesentério/patologia , Doenças Peritoneais/patologia , Idoso , Divertículo/complicações , Humanos , Volvo Intestinal/diagnóstico por imagem , Doenças do Jejuno/complicações , Masculino , Mesentério/diagnóstico por imagem , Tomografia Computadorizada por Raios XAssuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Doenças do Íleo/complicações , Fístula Intestinal/complicações , Obstrução Intestinal/etiologia , Intestino Delgado , Doenças do Jejuno/complicações , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/administração & dosagem , Antiulcerosos/administração & dosagem , Antiulcerosos/efeitos adversos , Aspirina/administração & dosagem , Aspirina/efeitos adversos , Feminino , Humanos , Doenças do Íleo/induzido quimicamente , Doenças do Íleo/diagnóstico por imagem , Fístula Intestinal/induzido quimicamente , Obstrução Intestinal/diagnóstico por imagem , Perfuração Intestinal/induzido quimicamente , Perfuração Intestinal/diagnóstico por imagem , Doenças do Jejuno/induzido quimicamente , Doenças do Jejuno/diagnóstico por imagem , Omeprazol/administração & dosagem , Omeprazol/efeitos adversos , Tomografia Computadorizada por Raios XRESUMO
An 81-year-old man was diagnosed with Goodpasture syndrome (GS) because he met the criteria of positive anti-GBM antibodies, rapid progressive glomerulonephritis and pulmonary hemorrhage. After starting plasmapheresis and steroid pulse therapy, he experienced tarry stool and contrast-enhanced CT revealed an aneurysmal finding in the jejunum. Paroral enteroscopy showed a jejunal Dieulafoy's lesion (DL) with gush-out hemorrhage. Hemostasis was successfully achieved by hemoclipping, and he then experienced no re-bleeding events. GS can present as a jejunal DL, and contrast-enhanced CT is useful for investigating the etiology and site of small intestinal bleeding, which can lead to smooth, effective endoscopic hemostasis.