SINGLE LARGE SACCULATED DUODENOJEJUNAL FLEXURE DIVERTICULUM. CASE REPORT AND CLINICAL IMPACT
Keywords:
JEJUNUM, DIVERTICULUM, DIVERTICULITISAbstract
A diverticulum can develop in any portion of the intestine. Jejunal diverticulum is a rare congenital malformation and refers to the presence of a sac-like mucosal herniation through vulnerable points of the intestinal wall. We herein report a case of an unusual finding of a single giant sacculated jejunal diverticulum located at the first part of the jejunum just after the duodenojejunal flexure in a cadaver. Diverticula usually remain entirely asymptomatic and commonly present with bloating and nonspecific symptoms. In many cases diagnosis is incidentally reached during surgery, endoscopy or imaging study for other reason. However, serious complications may develop, such as bowel obstruction and acute perforation, diverticulitis, bleeding, volvulus, anemia, malabsorption. Related clinical and surgical implications are discussed as well. Knowledge and familiarity with this rare entity is valuable to gastroenterologists when assessing abdominal symptoms and general surgeons, as well, when performing exploratory laparotomy. Although jejunal diverticular disease is a rare condition, potential complications could be fatal.
References
2. Altemeier WA, Bryant LR, Wulsin JH. The surgical significance of jejunal diverticulosis. Arch Surg 1963; 86: 732- 745.
3. Noer T. Non-meckelian diverticula of the small bowel: the incidence in an autopsy material. Acta Chir Scand 1960; 120: 175-179.
4. Maglinte DD, Chernish SM, DeWeese R, Kelvin FM, Brunelle RL. Acquired jejunoileal diverticular disease: subject review. Radiology 1986; 58: 577-580.
5. Butler JS, Collins CG, McEntee GP. Perforated jejunal diverticula: a case report. Journal of Medical Case Reports 2010; 4: 172.
6. Cooper A. Anatomy and surgical treatment of crural umbilical hernia. London, 1807.
7. Soemmering ST, Baille M. Anatomie des krankhaften Baues von einigen der wichtigsten Theile im menschlischen Korper. Berlin: Vossiche Buchhandlung, 1794.
8. Osler W. Notes on intestinal diverticula. Ann Anat Surg 1881; 4: 202.
9. Gordinier HC, Sampson JA. Diverticulitis (not Meekel's) causing intestinal obstruction. JAMA 1906; 46: 1585-1590.
10. Surov A, Stock K. Jejunal Diverticulosis. Eur J Med Res 2005; 10: 358-360.
11. Singh VV, Toskes PP: Small bowel bacterial overgrowth: Presentation, Diagnosis and treatment. Curr Gastrenterol Rep 2003; 5: 365-372.
12. Bitterling H, Rock C, Reiser M. Computed tomography in the diagnosis of inflammatory bowel dis-ease-methodology of MSCT and clinical results. Radiologe 2003; 43: 17-25.
13. Benson RE, Dixon CF, Waugh JM. NonMeckelian diverticula of the jejunum and ileum. Ann Surg 1943; 118: 377-393.
14. Baskin RH Jr, Mayo CW. Jejunal diverticulosis: a clinical study of 87 cases. Surg Clin North Am 1952; 32: 1185-1196.
15. Thorek M, Manzanilla MA Jr. Perforated jejunal diverticula: review of the literature and and report of a case. J Int Coll Surg 1954; 21: 409-418.
16. Krishnamurthy S, Kelly MM, Rohrmann CA, Schuffler MD: Jejunal diverticulosis. A heterogeneous disorder caused by a variety of abnormalities of smooth muscle or myenteric plexus. Gastrenterol 1983; 85: 538-547.
17. Aydın E, Yerli H, Avcı T, Yılmaz T, Gülay H. One of the Rare Causes of Acute Abdomen Leading to Subileus: Jejunal Diverticulitis. Balkan Med J. 2016; 33(3): 354-356.
18. Akhrass R, Yaffe MB, Fischer C, Ponsky J, Shuck JM: Small-bowel diverticulosis: perceptions and reality. J Am Coll Surg 1997; 184: 383-388.
19. Woods RJ, Lavery IC, Fazio VW, Jagelman DG, Weakley FL. Internal fistulas in diverticular disease. Dis Colon Rectum. 1988; 31(8): 591-596.
20. Chendrasekhar A, Timberlake GA. Perforated jejunal diverticula: an analysis of reported cases. Am Surg 1995; 61: 984-988.
21. Kassahun WT, Fangmann J, Harms J, Bartels M, Hauss J. Complicated small-bowel diverticulosis: A case report and review of the literature. World J Gastroenterol 2007; 13(15): 2240-2242.
22. Hu JL, Chen WZ. Midgut volvulus due to jejunal diverticula: a case report. World J Gastroenterol 2012; 18(40): 5826-5829.
23. Englund R, Jensen M. Acquired diverticulosis of the small intestine: case reports and literature review. Aust N Z J Surg 1986; 56: 51-54.
24. Shrivastava A, Shukla YP, Gupta A, Shrivastava J. A Rare Case of Large Jejunal Diverticulum Pre-senting as Intestinal Obstruction Due to Small Bowel Volvulus. Indian J Surg 2015; 77(Suppl 1): S77–S78.
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