Small bowel diverticular disease; how often we come across in exploratory laparotomy

ABSTRACT

1]. To see the prevalence of small bowel diverticulosis in patients presenting with acute abdomen. 2]. To know presentation and complications of diverticulosis in teaching hospital in Sialkot region of Pakistan. Introduction: Small bowel diverticular disease may be complicated by small bowel obstruction. Multiple diverticulosis represents an uncommon pathology of the small bowel. Related complications such as diverticulitis, perforation, bleeding or intestinal obstruction, and acute pancreatitis appear in 10-30% of the patients, increasing the morbidity and mortality rates. This pathology which is uncommon is much higher in our study in patients undergoing exploratory laparotomy in district level hospitals in Sialkot region of Pakistan. Prospective and observational. Combined Military Hospital, Sialkot [June 2005 to August 2010]. Islam teaching hospital, Sialkot [September 2010 to September 2012]. 260 consecutive patients undergoing exploratory laparotomy for obstruction, peritonitis, pain and mass abdomen were included in the study. Patient with established cause of obstruction were excluded. The data including demographic information, presentation, operative findings, complications and follow up were entered in structured proforma. Patients with less than three months of followup were also excluded from study. Small bowel diverticuli were encountered in 24 [9%] out of 260 patients including; 8 [3%] Meckel's, 9 [3.5%] jejunal, 3 [1.2%] duodenal and 4 [1.5%] Heal diverticuli. These patients with diverticuli presented as intestinal obstruction, peritonitis, mass abdomen, vague abdominal pain and one patient with fresh bleeding per rectum. The indications of surgery were peritonitis 6 [25%], intestinal obstruction 13 [54.2%], abdominal mass 3[12.5%], nonspecific abdominal pain 1 [4.2%] and fresh bleeding per rectum of obscure origin 1 [4.2%]. Complications encountered as Intestinal obstruction due to adhesion formation in 8; obstruction due to congenital bands attached to diverticuli in 3; diverticular perforation in 2; peritonitis due to diverticulitis in 2,bleeding from arteriovenous malformation within the jejuna diverticuli in 1 and mass formation due to volvulus in 1. Three duodenal diverticuli and 4 jejunal diverticuli were found as silent pathologies synchronous with other active pathologies