Saudi Journal of Gastroenterology
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LETTER TO THE EDITOR  
Year : 2011  |  Volume : 17  |  Issue : 5  |  Page : 367
Perforated jejunal diverticulum: A rare complication


1 Department of General Surgery, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
2 Department of Surgery, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India

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Date of Web Publication6-Sep-2011
 

How to cite this article:
Singh S, Sandhu HP, Aggarwal V. Perforated jejunal diverticulum: A rare complication. Saudi J Gastroenterol 2011;17:367

How to cite this URL:
Singh S, Sandhu HP, Aggarwal V. Perforated jejunal diverticulum: A rare complication. Saudi J Gastroenterol [serial online] 2011 [cited 2021 Feb 25];17:367. Available from: https://www.saudijgastro.com/text.asp?2011/17/5/367/84502


Sir,

Jejunal diverticula are uncommon, acquired lesions which are usually asymptomatic. When symptomatic they present with chronic nonspecific symptoms like pain, nausea, malnutrition and sometimes with acute presentation like gastrointestinal hemorrhage, peritonitis and obstruction. While chronic pain and malabsorption occurs in 40% of cases, perforation occurs only in 2.3-6.4% of all diverticula-bearing patients. [1]

We report a case of 60-year-old male, who presented in the emergency with generalized abdominal pain, distension and constipation since four days. The patient had a past history of frequent abdominal pain since three years. On general physical examination he had tachypnea, tachycardia and blood pressure was within normal range. Per abdominal examination revealed distension, generalized tenderness, guarding and rigidity. Routine laboratory investigations were within normal limits. Abdominal X- ray displayed air under both the domes of the diaphragm. On laparotomy, multiple jejunal diverticula were present on the mesenteric side. A perforation measuring 0.5 × 0.5 cm was found in the diverticulum which was approximately 2 feet distal to the duodenojejunal junction [Figure 1]. Peritoneal lavage with resection of only perforation-bearing segment with end to end anastomosis was done. Postoperative course was uneventful.
Figure 1: Perforation of jejunal diverticulum along with multiple diverticula on the mesenteric side

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Jejunal diverticula are pseudo diverticula which were first described by Somerling in 1794 and by Sir Astley Cooper in 1807. Their incidence on enteroclysis is 2.0-2.3% and on autopsy it is 0.06-4.6%. [1] They are more common in elderly males (58%). [2] The most common part of the small bowel to be affected by diverticula is the proximal jejunum (75%), followed by the distal jejunum (20%) and the ileum (5%). Coexistent diverticula can be present in the colon (30-75%), duodenum (15-42%), esophagus (2%), stomach (2%) and urinary bladder (12%) of patients. [3]

Jejunal diverticula are usually found incidentally on small bowel radiography such as double-contrast enteroclysis or at surgery. Perforation of jejunal diverticula is a rare complication. Peritonitis caused by perforated jejunal diverticula can be localized and self-limiting because the diverticula are at the mesenteric border of the bowel and readily allow the small bowel mesentery to wall them off. The treatment of choice for perforated jejunal diverticulum with peritonitis is segmental intestinal resection with primary anastomosis including non-inflamed diverticula. [4] If the diverticula are extensive, resection may have to be limited to the segment containing the perforated diverticulum to avoid short bowel syndrome. Other procedures like simple closure, excision, and invagination, are associated with an approximately three times greater mortality rate. Simple diverticulectomy may impair blood flow because of its mesenteric location, and therefore may lead to anastomotic breakdown or fistula formation. The reported overall mortality rate is 24%, with a mortality rate of 14% in cases where resection of the involved segment with primary anastomosis was done. [5] The high mortality appears to be related to the advanced age of the patients as well as to delayed diagnosis and treatment.

 
   References Top

1.Makris K, Tsiotos GG, Stafyla V, Sakorafas GH. Small intestinal nonmeckelian diverticulosis: clinical review. J Clin Gastroenterol 2009;43:201-7.  Back to cited text no. 1
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2.Tsiotos GG, Farnell MB, IIstrup DM. Nonmeckelian jejunal or ileal diverticulosis: An analysis of 112 cases. Surgery 1994;116:726-32.  Back to cited text no. 2
    
3.de Bree E, Grammatikakis J, Christodoulakis M, Tsiftsis D. The clinical significance of acquired jejunoileal diverticula. Am J Gastroenterol 1998;93:2523-8.  Back to cited text no. 3
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4.Herrington JL Jr. Perforation of acquired diverticula of the jejunum and ileum: Analysis of reported cases. Surgery 1962;51:426-33.  Back to cited text no. 4
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5.Roses DF, Gouge TH, Scher KS, Ranson JH. Perforated diverticula of the jejunum and ileum. Am J Surg 1976;132:649-52.  Back to cited text no. 5
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Correspondence Address:
Sumitoj Singh
Department of General Surgery, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-3767.84502

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