Enfermedad diverticular yeyuno-ileal complicada tratada quirúrgicamente: serie de 12 casos y revisión de literatura / Complicated jejunoileal diverticular disease: a 12 cases' serie and literature review

Objetivo: Realizar un análisis retrospectivo de una serie de casos de diverticulitis yeyuno-ileal complicadas tratadas quirúrgicamente en nuestro servicio durante el periodo comprendido entre los años 2002 al 2015. Materiales y métodos: Se trató quirúrgicamente 12 casos de diverticulosis yeyuno-ileal complicadas, 7 mujeres y 5 varones. La edad media fue 76 años. La presentación clínica en todos los casos fue dolor abdominal agudo, uno de ellos con hemorragia digestiva. Todos presentaron leucocitosis, neutrofilia y aumento de reactantes de fase aguda. A todos los pacientes se les realizó TAC abdominal urgente. Resultados: En 11 casos hubo congruencia entre estudio de imagen y hallazgos quirúrgicos. La localización de los divertículos fue yeyuno (9) e íleon (3). Siempre se realizó laparotomía exploradora urgente encontrándose perforación diverticular con peritonitis (7 casos), perforación diverticular con absceso (4 casos) y en un caso un área isquémica con perforación diverticular tras embolización. Se realizó siempre resección intestinal y anastomosis. En ningún caso se conocía previamente el diagnóstico de diverticulosis yeyuno-ileal. Nuestras complicaciones fueron: Clavien I (2), Clavien IIIa (1), Clavien IVb (1), Clavien V (1). Conclusiones: La diverticulitis yetuno-ileal es una entidad infrecuente, suele ser la forma de debut de una enfermedad diverticular no conocida previamente. El TAC abdominal es de gran utilidad diagnóstica. La resección del segmento afecto es el tratamiento de elección

Objective: To perform a retrospective analysis of a series of complicated JID (jejunoileal diverticulitis) cases surgically treated in our service during the period from 2002 to 2015. Materials and methods: We treated 12 cases of jejunoileal complicated diverticulosis. 7 women and 5 men. The mean age was 76 years. The clinical presentation in all cases was acute abdominal pain, one with gastrointestinal bleeding. All cases had leukocytosis, neutrophilia and increased acute phase reactants. All patients underwent emergency abdominal CT. Results: In 11 cases, there was consistency between imaging studies and surgical findings. Diverticula were located: jejunum (9) and ileum (3). Urgent exploratory laparotomy was always done and findings were: diverticular perforation with peritonitis (7 cases), diverticular perforation with abscess (4 cases) and in one case an ischemic area with diverticular perforation after embolization. Intestinal resection and anastomosis was performed in all cases. There were no patients, in which the diagnosis of diverticulosis jejunoileal was previously known. Complications were: Clavien I (2), Clavien IIIa (1), Clavien IVb (1), Clavien V (1). Conclusions: Jejunoileal diverticulitis is a rare entity, usually the first sign of onset of diverticular disease not previously known. Abdominal CT is of great diagnostic value. Resection of the affected segment is the treatment of choice

Jejunal Varices Causing Recurrent Obscure Gastrointestinal Hemorrhage / 대한소화기학회지

No abstract available.

A case of variceal bleeding from the jejunum in liver cirrhosis

While esophagogastric varices are common manifestations of portal hypertension, variceal bleeding from the jejunum is a rare complication of liver cirrhosis. In addition, ectopic variceal bleeding occurs in the duodenum and at sites of previous bowel surgery in most cases, including of stomas. We report a case of obscure overt gastrointestinal bleeding from jejunal varices in a 55-year-old woman who had not previously undergone abdominal surgery, who had liver cirrhosis induced by the hepatitis C virus. Emergency endoscopy revealed the presence of esophageal varices without stigmata of recent bleeding, and no bleeding focus was found at colonoscopy. She continued to produce recurrent melena with hematochezia and received up to 21 units of packed red blood cells. CT angiography revealed the presence of jejunal varices, but no active bleeding was found. Capsule endoscopy revealed fresh blood in the jejunum. The patient submitted to embolization of the jejunal varices via the portal vein, after which she had a stable hemoglobin level and no recurrence of the melena. This is a case of variceal bleeding from the jejunum in a liver cirrhosis patient without a prior history of abdominal surgery.

Cytomegalovirus Jejunitis Diagnosed with Single-Balloon Enteroscopy / 대한소화기학회지

Cytomegalovirus (CMV) infections are usually diagnosed in immunocompromised patients. A 74-year-old male without any significant medical history visited our center because of abdominal pain and diarrhea which began about a month ago. Abdominal computed tomography revealed segmental enhanced bowel wall thickening on jejunum and single-balloon enteroscopy showed multiple geographic shaped ulcerations covered with exudates on proximal jejunum. Biopsy samples taken during endoscopic examination demonstrated necrotic fibrinopurulent tissue debris and benign ulcer. Nested-PCR analysis of CMV DNA from jejunal tissue was positive. The patient was finally diagnosed with CMV jejunitis and was treated by intravenous ganciclovir for 14 days after which, abdominal pain and diarrhea improved. Our case shows that CMV jejunitis can occur in an immunocompetent adult as multiple jejunal ulcers which can be diagnosed using a single-balloon enteroscope.

Complicated jejunal diverticulitis: a challenging diagnosis and difficult therapy

In contrast to diverticulosis of the colon, jejunal diverticulosis is a rare entity that often becomes clinically relevant only after exacerbations occur. The variety of symptoms and low incidence make this disease a difficult differential diagnosis. Data from all patients who were treated in our surgical department for complicated jejunal diverticulitis, that is, gastrointestinal hemorrhage or a diverticula perforation were collected prospectively over a 6-year period [January 2004 to January 2010] and analyzed retrospectively. The median age among the 9 patients was 82 years [range: 54-87]. Except for 2 cases [elective operation for a status postjejunal peridiverticulitis and a re-perforation of a diverticula in a patient s/p segment resection with free perforation], the diagnosis could only be confirmed with an exploratory laparotomy. Perforation was observed in 5 patients, one of which was a retroperitoneal perforation. The retroperitoneal perforation was associated with transanal hemorrhage. Hemodynamically relevant transanal hemorrhage requiring transfusion were the reason for an exploratory laparotomy in 2 further cases. In one patient, the hemorrhage was the result of a systemic vasculitis with resultant gastrointestinal involvement. A singular jejunal diverticulum caused an adhesive ileus in one patient. The extent of jejunal diverticulosis varied between a singular diverticulum to complete jejunal involvement. A tangential, transverse excision of the diverticulum was carried out in 3 patients. The indication for segment resection was made in the case of a perforation with associated peritonitis [n=4] as well as the presence of 5 or more diverticula [n=2]. Histological analysis revealed chronic pandiverticulitis in all patients. Median operating time amounted to 142 minutes [range: 65-210] and the median in-hospital stay was 12 days [range: 5-45]. Lethality was 0%. Major complications included secondary wound closure after s/p repeated lavage and bilateral pleural effusions in one case. Signs of malabsorption as the result of a short bowel syndrome were not observed. Minor complications included protracted intestinal atony in 2 cases and pneumonia in one case. Median follow-up was 6 months [range: 1-18]. Complicated jejunal diverticulitis often remains elusive preoperatively due to its unspecific clinical presentation. A definitive diagnosis can often only be made intraoperatively. The resection of all diverticula and/or the complete diverticula-laden segment is the goal in chronic cases. The operative approach chosen [tangential, transverse excision vs segment resection] should be based on the extent of the jejunal diverticulosis as well as the intraoperative findings

A Case of Idiopathic Recurrent Duodenojejunitis / 대한소화기학회지

There are various etiologies of duodenojejunitis such as Henoch-Schonlein purpura (H-S purpura), vasculitis, Crohn's disease, celiac sprue, ischemia, lymphoma, Zollinger-Ellison syndrome, bacteria or parasite infection, radiation, drug induced jejunitis, eosinophilic jejunitis, and toxins. A 31-year-old man presented with left upper quadrant pain. He did not have febrile sense, hematochezia, melena, diarrhea, arthralgia and hematuria. He had neither drug history nor traveling history. Esophagogastroduodenoscopy showed diffuse mucosal erythema and segmental hemorrhagic erosions on the distal area to the descending portion of the duodenum and proximal jejunum, which were commonly observed in the gastrointestinal involvement of H-S purpura. However, he showed no skin lesions, joint and urologic problems until the discharge. Autoimmune markers such as antinuclear antibody and antineutrophil cytoplasmic antibody were negative. Celiac and mesenteric angiogram showed no vascular abnormality. After the administration of oral prednisolone 40 mg daily for therapeutic trial, abdominal pain and endoscopic lesions were improved. He experienced relapses of same episode without skin lesions 16 times during follow-up of 8 years, which were also treated with prednisolone. The abdominal computed tomography during the follow-up also showed no significant finding. We report a case of primary recurrent duodenojejunitis similar to the gastrointestinal involvement of H-S purpura without purpura.

Magnetic toy ingestion leading to jejunocecal fistula in a child

The accidental ingestion of a foreign body is a common problem in children, but ingestion of magnets is rare. When multiple magnets are ingested, they may attract each other and cause pressure necrosis through the bowel walls and eventually lead to serious complications like obstruction, perforation, and fistula formation. We report a case of a 5-year-old girl with jejunocecal fistula following ingestion of 2 magnet toys; it highlights the diagnostic challenge and the need for early surgical intervention in children especially when multiple magnets are ingested

Chronic Non-granulomatous Ulcerative Jejunoileitis Assessed by Wireless Capsule Endoscopy / 대한소화기학회지

Chronic non-granulomatous jejunoileitis is a rare disease characterized by malabsorption, abdominal pain, and diarrhea that causes shallow ulcers in the small bowel. The etiology of chronic non-granulomatous jejunolieitis remains unknown. A 69-year-old man complained of abdominal pain and lower extremity edema. A 99m-Tc albumin scan showed increased radioactivity at the left upper quadrant, suggesting protein-losing enteropathy. A small bowel follow-through did not disclose any lesions. Wireless capsule endoscopy revealed several small bowel ulcers and strictures. A jejunoileal segmentectomy with end-to-end anastomosis was performed, and the histologic examination revealed non-granulomatous ulcers with focal villous atrophy. Ruling out all other possible diagnoses, we diagnosed our patient with chronic non-granulomatous ulcerative jejunoileitis. Postoperatively, the patient's abdominal pain and lower extremity edema improved, and the serum albumin normalized. This is the first case of chronic non-granulomatous ulcerative jejunoileitis localized by wireless capsule endoscopy and treated successfully with segment resection.

Diaphragm disease of the jejunum

Non-steroidal anti-inflammatory drugs [NSAIDs] are associated with the development of diaphragm disease. We report a 73-year-old male patient with this condition who had used NSAIDs for 2 years. He presented with general weakness, syncopal attacks, and a short history of melena. At laparotomy, multiple areas of constricted bowel were found in the resected proximal jejunum. Gross and microscopic examination confirmed diaphragm disease. The relevant literature is reviewed

Small Intestinal Perforation Caused by Primary Jejunal MALT Lymphoma / 대한소화기학회지

No abstract available.

Retrograde jejunogastric intussusception (JGI) with strangulation following previous gastrojejunostomy.

Jejunogastric intussusception is a rare but potentially very serious complication of gastrectomy or gastrojejunostomy. To avoid mortality early diagnosis and prompt surgical intervention is mandatory. A young man presented with epigastric pain and bilous vomiting followed by haematemesis 15 years after vagotomy & gastrojejunostomy for chronic duodenal ulcer. At presentation the patient was in shock and an emergency laparotomy was done after resuscitation. At laparotomy a retrograde type II JGI was found and managed by resection of the affected segment and partial gastrectomy and jejuno - jejunostomy with closure of the duodenal stump. Postoperative recovery was uneventful. Retrograde JGI is a rare condition and only less than 200 cases have been reported since its first report. Clinical picture of acute intestinal obstruction with suspicion about the condition in patients having a past history of gastrojejunostomy makes the elusive diagnosis definite and demands early surgery to reduce the grave consequences of the disease.

Visualization of Jejunal Bleeding by Capsule Endoscopy in a Case of Eosinophilic Enteritis

Eosinophilic enteritis is a rare disease characterized by tissue eosinophilia, which can affect different layers of bowel wall. Normally, the disease presents as colicky abdominal pain, and rarely as an acute intestinal obstruction or perforation. In this paper, we report a case of eosinophilic enteritis, hitherto unreported, presenting as an ileal obstruction, and followed by jejunal bleeding, which was visualized by capsule endoscopy. A 62-year-old man received a 15 cm single segmental ileal resection at a point 50 cm from the IC valve due to symptoms of obstruction, which were diagnosed as eosinophilic enteritis. Seventeen days after operation, intermittent abdominal pain occurred again, and subsided upon 30 mg per day treatment with prednisolone. Fourteen days after this pain attack, the patient exhibited hematochezia, in spite of continuous prednisolone treatment. Capsule endoscopy showed fresh blood spurting from the mid-to-distal jejunum, in the absence of any mass or ulcer. This hematochezia rapidly disappeared following a high-dose steroid injection, suggesting it was a manifestation of jejunal eosinophilic enteritis.

Perforation in a jejunal duplication lined by ectopic gastric mucosa.

We report a 3-year-old child with jejunal duplication with localized perforation and bleeding in the adjacent normal intestine. The entire duplicated jejunum was lined by gastric mucosa. This was successfully treated by mucosal excision of the duplicated intestine and resection of a short segment of normal jejunum.

Portal hypertensive jejunopathy: a case control study.

BACKGROUND: Small bowel mucosa is a recognized potential source of bleeding in portal hypertension. However, the frequency of its involvement is not known. AIMS: To document the nature, severity and frequency of endoscopic and histologic changes in the jejunum in patients with portal hypertension. METHODS: Forty consecutive patients with portal hypertension and 43 patients with non-ulcer dyspepsia (controls) underwent push enteroscopy and jejunal, duodenal and gastric biopsies. Biopsies were randomized and examined by a blinded pathologist for inflammation and vascular dilatation, which was quantified by morphometry. RESULTS: Endoscopic jejunopathy was observed in 6 patients and none of the control subjects. All patients with jejunopathy had portal hypertensive gastropathy (PHG) and 5 had duodenopathy. Vascular dilatation was observed in 15 patients and 25 control subjects (p = ns). The degree of vascular dilatation was similar in both groups. Inflammatory changes were observed in 24 patients and 25 control subjects (p = 0.05). CONCLUSIONS: Endoscopic jejunopathy was present in 15% of patients with portal hypertension. These changes were mild in 83% of them. All patients with jejunopathy also had PHG. Histologic changes were similar in patients and control subjects.

A Case of Jejunal Infarction and Perforation due to Acute Pancreatitis / 대한소화기학회지

Jejunal infarction as a complication of acute pancreatitis is not common and can not be well recognized. This jejunal infarction usually arises from the venous thrombosis rather than arterial thrombosis. Jejunal infarction results in bowel perforation or stenosis according to its extension of injury and progression rate. Pathologic findings of the involved jejunum show a segmental transmural infarction and mesenteric venous thrombotic occlusions. Early diagnosis should be made for better prognosis. We report a patient with jejunal infarction resulting perforation due to acute pancreatitis, in which the initial presenting symptoms were hematemesis and abdominal distention.