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Jejunal Diverticulosis


Presentation

  • As a result of the variety of presentations, complications of jejunal diverticulosis present a diagnostic and therapeutic challenge for the acute care surgeon.[ncbi.nlm.nih.gov]
  • If none of these signs are present, uncomplicated enterolith ileus is present. In uncomplicated enterolith ileus (21 patients), more often milking and crushing or enterotomy was performed.[ncbi.nlm.nih.gov]
  • Though rare, jejunal diverticulosis can present with several life-threatening complications that mandates immediate surgery.[ncbi.nlm.nih.gov]
  • When inflamed or perforated, jejunal diverticulosis may present with paralytic ileus. In contrast, mechanical bowel obstruction is an unusual presentation.[ncbi.nlm.nih.gov]
  • This is a case presentation of a 27-year-old woman with a history of necrotising enterocolitis (NEC) requiring surgical resection as a premature newborn who presented with recurrent abdominal pain and was found to have several small bowel diverticula[ncbi.nlm.nih.gov]
Anemia
  • A case of left-sided paraduodenal hernia and jejunal diverticulosis is described in 75-year-old man who presented with chronic intermittent abdominal pain, weight loss, and anemia.[ncbi.nlm.nih.gov]
  • Medical therapy is helpful in controlling diarrhea and anemia, while surgical therapy can give excellent results in treating complications or refractory symptoms.[ncbi.nlm.nih.gov]
  • As anemia was not improved by conservative therapy and selective superior mesenteric angiogram revealed a bleeding lesion in the jejunum, emergency operation was performed.[jlc.jst.go.jp]
  • Anemia due to iron deficiency and megaloblastic anemia have often been reported and commonly attributed to malabsorpion, steatorreia, and vitaminic deficit [ 23 , 33 ].[wjes.biomedcentral.com]
  • General blood picture showed presence of toxic granulations and features of macrocytic anemia. Serum protein levels were markedly reduced. Abdominal X-ray displayed multiple dilated loops of small bowel.[casereports.in]
Raynaud Phenomenon
  • Five had Raynaud's phenomenon and heartburn, and 2 had dysphagia. At radiography, 9 had jejunal diverticula with or without duodenal or ileal diverticula, or both. Two each had abnormal structure or motility of the esophagus or stomach.[ncbi.nlm.nih.gov]
Turkish
Abdominal Pain
  • A 33-year man repeatedly presented to emergency with abdominal pain which resolved with analgesics until he developed constipation, vomiting, fever and severe abdominal pain. He had to undergo laparotomy which revealed multiple jejunal diverticula.[ncbi.nlm.nih.gov]
  • It may present with chronic abdominal pain, diarrhoea, bloating and complications including malabsorption, diverticulitis, bleeding, intestinal obstruction or perforation.[ncbi.nlm.nih.gov]
  • Ten patients complained of chronic abdominal pain, in eight of whom the cause was not diagnosed until other complications supervened.[ncbi.nlm.nih.gov]
  • A case of left-sided paraduodenal hernia and jejunal diverticulosis is described in 75-year-old man who presented with chronic intermittent abdominal pain, weight loss, and anemia.[ncbi.nlm.nih.gov]
  • Jejunal diverticulosis is an uncommon condition, but it is often associated with a number of symptoms including postprandial abdominal pain, distension, flatulence, borborygmus, nausea, vomiting, diarrhea and constipation and with complications such as[ncbi.nlm.nih.gov]
Nausea
  • Jejunal diverticulosis is an uncommon condition, but it is often associated with a number of symptoms including postprandial abdominal pain, distension, flatulence, borborygmus, nausea, vomiting, diarrhea and constipation and with complications such as[ncbi.nlm.nih.gov]
  • We present the association of enterolithiasis and jejunal diverticulosis causing obstruction of the small intestine in a 74-year-old female who was admitted for abdominal cramps, nausea and vomiting.[ncbi.nlm.nih.gov]
  • It is most often asymptomatic but presenting symptoms are nonspecific and include abdominal pain, nausea, diarrhea, malabsorption, bleeding, obstruction, and/or perforation.[ncbi.nlm.nih.gov]
  • During the 2 years before the current presentation, she had reported having frequent episodic nausea, abdominal distention, and colic followed by violent fecaloid vomiting.[nejm.org]
Hematochezia
  • […] computed tomography (CT) angiography, CT enterography, and conventional angiography can also be used to delineate obscure sources of GIB. 1 Case Report A 63-year old woman was referred to our institution from a community hospital with a 3-day history of hematochezia[acgcasereports.gi.org]
  • A hemoglobin level is important in patients who report hematochezia. Electrolyte assays may be helpful in the patient who is vomiting or has diarrhea. Assess renal function prior to the administration of most intravenous contrast material.[emedicine.medscape.com]
Abdominal Fullness
  • Vague and chronic, mainly post prandial, epigastric cramping pain, bloating or abdominal fullness is usually referred.[wjes.biomedcentral.com]
Recurrent Abdominal Pain
  • This is a case presentation of a 27-year-old woman with a history of necrotising enterocolitis (NEC) requiring surgical resection as a premature newborn who presented with recurrent abdominal pain and was found to have several small bowel diverticula[ncbi.nlm.nih.gov]
Papule
  • Larger, disfiguring hemangiomas and darker, flat macules or papules also may develop. The small bowel is the most commonly affected site; however, any part of the GI tract can be involved. Blebs in the colon most often are located distally.[consultant360.com]

Workup

  • Workup of these symptoms included computed tomography, which showed small-bowel dilatation along with a whirl sign and numerous collateral veins, suggestive of a midgut volvulus (see video ).[nejm.org]
  • See Workup for more detail. Treatment of diverticulitis The management of patients with diverticulitis depends on their presentation severity, presence of complications, and comorbid conditions.[emedicine.medscape.com]

Treatment

  • The treatment is mainly surgical; however, there have been cases where nonsurgical management was successful.[ncbi.nlm.nih.gov]
  • Resection is the treatment of choice for relieving symptoms, and for preventing or treating complications.[ncbi.nlm.nih.gov]
  • The clinical significance, diagnostic evaluation and treatment of jejunal diverticulosis are reviewed.[ncbi.nlm.nih.gov]
  • This was accompanied by a literature search to identify the different modalities for diagnosis and treatment of this condition. JD is rare and may lead to a diagnostic delay.[ncbi.nlm.nih.gov]
  • Mostly surgical exploration is necessary because obstruction symptoms are unresponsive to medical treatment.[ncbi.nlm.nih.gov]

Prognosis

  • Telomere Length in Leukocyte DNA in Gastric Cancer Patients and its Association with Clinicopathological Features and Prognosis.[hospital.fujita-hu.ac.jp]
  • […] gas and fluid into pelvis and peritoneal cavity abscess formation (seen in up to 30% of cases) may contain fluid, gas or both fistula formation (usually a chronic complication) gas in the bladder direct visualization of a fistulous tract Treatment and prognosis[radiopaedia.org]
  • Mortality/Morbidity The prognosis is good even with complications.[emedicine.medscape.com]
  • The prognosis in patients with diverticulitis depends on the severity of the illness, the presence of complications, and the presence of any coexisting medical problems.[emedicine.medscape.com]

Etiology

  • A 78-year-old man with bowel obstruction of unknown etiology was initially managed conservatively, but suffered recurrence of the obstruction.[ncbi.nlm.nih.gov]
  • A literature review has revealed that these signs have been present in other cases of jejunal diverticulosis, although the etiology and pathophysiology is not clearly understood.[paperity.org]
  • Comment Jejunal diverticulosis was first reported in 1807 by Sir Astley Paston Cooper. 2 The exact etiology is unknown; however, it has been speculated to be a result of abnormal peristalsis, dyskinesia, and high intraluminal pressures.[ispub.com]
  • This is the second reported case of a giant congenital jejunal diverticulum presenting with diverticulitis and perforation in a child. [3] The etiology of true jejunal diverticulosis is unknown.[saudisurgj.org]
  • The etiology is unclear; it is believed to develop as the result of abnormalities in peristalsis, intestinal dys-kinesis, and high segmental intraluminal pressures.[abdominalsurg.org]

Epidemiology

  • A brief review of the epidemiology, pathogenesis, and clinical presentation displays the variety of symptoms associated with these rare conditions.[ncbi.nlm.nih.gov]
  • As diverticulosis occurs in an older population such complications are serious events. [ citation needed ] Epidemiology [ edit ] The prevalence of diverticulosis progressively increases with age.[en.wikipedia.org]
  • Diverticular disease as a chronic illness: evolving epidemiologic and clinical insights. Am J Gastroenterol . 2012 Oct. 107 (10):1486-93. [Medline] . Brandl A, Kratzer T, Kafka-Ritsch R, Braunwarth E, et al.[emedicine.medscape.com]
  • Epidemiology Frequency United States Duodenal diverticula are approximately 5 times more common than jejunoileal diverticula. The actual incidence of both types of diverticula is not known because these lesions are usually asymptomatic.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology, Diagnosis, Management, 2nd Ed. Philadelphia, Saunders, 1978, pp 1094–1103 Google Scholar 11. Ament ME, Shimoda SS, Saunders DR, et al: Pathogenesis of steatorrhea in three cases of small intestinal stasis syndrome.[springerlink.com]
  • A literature review has revealed that these signs have been present in other cases of jejunal diverticulosis, although the etiology and pathophysiology is not clearly understood.[paperity.org]
  • . // British Medical Journal;7/26/1980, Vol. 281 Issue 6235, p273 Diarrhoea is occasionally encountered during cimetidine treatment but no satisfactory pathophysiological mechanism has been proposed.[connection.ebscohost.com]
  • "Etiology and pathophysiology of diverticular disease". Clinics in Colon and Rectal Surgery. 17 (3): 147–53. doi : 10.1055/s-2004-832695. PMC 2780060. PMID 20011269.[en.wikipedia.org]
  • Pathophysiology 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.[emedicine.medscape.com]

Prevention

  • Resection is the treatment of choice for relieving symptoms, and for preventing or treating complications.[ncbi.nlm.nih.gov]
  • Awareness of the wide spectrum of potential complications can prevent this delay.[ncbi.nlm.nih.gov]
  • Because jejunal diverticula may be encountered during a sonographic examination, sonologists should be aware of their sonographic appearance to prevent diagnostic errors.[ncbi.nlm.nih.gov]
  • "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence.[turkiyeklinikleri.com]
  • Overall, there is a lack of good quality scientific evidence on how to prevent diverticular disease. 0 Reply Diverticulitis.[dailyrounds.org]

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