Mesenteric diverticuli as a reason of acute abdomen

Czech version

Authors: M. Skála; V. Liška; V. Třeška
Authors‘ workplace: Chirurgická klinika, Univerzita Karlova, Lékařská fakulta v Plzni, Fakultní nemocnice Plzeň
Published in: Rozhl. Chir., 2019, roč. 98, č. 1, s. 27-30.
Category: Case Report

Overview

Introduction:

Diverticula of the small bowel are quite rare findings, frequently confirme only by necropsy. The authors describe the signs and symptoms resulting from complications of small bowel diverticula as well as the diagnostic options and treatment modalities. The paper also presents the results of treatment in the Department of Surgery at University Hospital in Pilsen.

Method:

Our retrospective study involved 6 patients who were operated on due to complications of small bowel mesenteric diverticulum at the Department of Surgery at University Hospital in Pilsen between 1 January 2006 and 1 January 2016. We assessed the number of days in hospital, emesis or pathological stools (diarrhoea or bleeding), admission body temperature and abdominal clinical signs, operating time and postoperative complications according to the Clavien-Dindo classification. As for laboratory parameters, leukocytosis and C-reactive protein levels were evaluated.

Results:

The results of our study are similar to those reported in available literature. After medical history and physical examination which are necessary, laboratory methods, and less frequently also imaging methods, can be used in diagnosis. The treatment of complications of small bowel diverticular disease is only surgical. The postoperative course is burdened by comorbidities of these patients as they are very often elderly.

Conclusion:

Management of complicated small bowel diverticular disease is only surgical and consists in laparotomy with thorough lavage of the abdominal cavity and with drainage.

Key words:

small bowel − acute abdome

Sources

Třeška V, Kural T. Divertikuloza tenkého střeva. Rozhl Chir 1992;71:133−5.
Williams RA, Davidson DD, Serrota AI, et al. Surgical problems of diverticula of the small intestine. Surg Gynecol Obstet 1981;152:621−6.
Tsiotos GG, Farnell MB, Ilstup DM. Non-Meckelian jejuna lor ileal diverticulosis: an analysis of 112 cases. Surgery 1994;116:726−32.
Ross CB, Richards WO, Sharp KW, et al. Diverticular disease of the jejunumand its complications. Am Surg 1990;56:319−24.
Sarioglu-Buke A, et al. An uncommon variant of Meckel’s diverticulum. J can chir 2008;5:E46–E47.
Fidan N, Mermi EU, Aclay MB, et al. Jejunal diverticulosis presented with acute abdomen and divertikulitis complication: A case report. Pol J Radiol 2015;80:532–5.
Štukavec J, Ducháč V, JirásekT. Divertikulární onemocnění tenkého střeva – vlastní soubor a kazuistika. Rozhl Chir 2005;84:589–91.
Šubrt Z, Páral J, Kaška M. Divertikulóza jejuna jako raritní zdroj masivního krvácení do gastrointestinálního traktu. Rozhl Chir 2004;83:514−17.
Akhrass R, Yaffe MB, Fisher C, et al. Small-bowell diverticulosis: perceptions and reality. J Am Coll Surg 1997;184:383−8.
Antoš Z, Tietz A, Bělohlávek O, et al. Mnohočetná divertikulóza jejuna jako příčina opakovaných subileózních stavů. Vnitř Lék 1994;40:513–6.
Bree E, Grammatikakis J, Christodoulakis M, et al. The clinical significance of acquired jejunoileal diverticula. Am J Gastroenterol 1998;93:2523−8.
Mendonca HL, Vieta JO, et al. Jejunal diverticulosis with masive hemorrhage. Am J Gastroenterol 1978;70:657−9.
Baskin RH jr, Mayo CW. Jejunal diverticulosis; a clinical study of 87 cases. Surg Clin North Am 1952;152:1185−96.
Benson RE, Dixon CF, Waugh JM. Non-Meckelian diverticula of the jejunum and ileum. Ann Surg 1943;118:377−93.
Gueye ML, Thiam O, Seck M, et al. Perforated mesenteric Meckel’s diverticulum in an adult: a real variant? Journal of Surgical Case Reports. On line 2015. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555003/
Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250:187−96.
Kaška M, Pospíšil I, Andrejsová H, et al. Divertikulóza tenkého střeva – kazuistika. Rozhl Chir 2000;79:221−3.
Gupta S, Kumar N. Jejunal diverticula with perforation in non steroidal anti inflammatory drug user: A case report. International Journal of Surgery Case Reports 2017;38:111−4.
Falidas E, Vlachos K, Mathiolakis S, et al. Multiple giant diverticula of the jejunum causing intestinal obstruction: report of a case and review of the literature. World J Emergeny Surg 2011. Available from: https://doi.org/10.1186/1749-7922-6-8.
Moláček J, Třeška V. Mnohočetná divertikulóza tenkého a tlustého střeva. Kazuistika. Rozhl Chir 2007;86:35–6.

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Article was published in

Perspectives in Surgery

2019 Issue 1