RESUMO
Jejunoileal diverticula (JD) are an uncommon condition most prevalent in the sixth and seventh decade of life. Although mostly asymptomatic, JD can be complicated by perforation, diverticulitis, abscess, bleeding, fistula, and small bowel obstruction (SBO) secondary to enterolith formation. There are a limited number of cases describing JD complicated by SBO secondary to enterolith formation. Most of these cases are not associated with diverticulitis and multiple JD are present in all but one previously reported case. We present a case of diverticulitis of a large, isolated jejunal diverticulum complicated by de novo enterolith-induced SBO initially diagnosed as intussusception based on computerized tomography (CT) imaging. Our main objective is to increase awareness that isolated JD are not as readily evident on imaging as cases presenting with multiple JD, but nevertheless should be considered as possible etiology of acute abdomen.
RESUMO
Ethnic disparities in pain assessment and analgesic administration following surgery have received little attention in the surgery literature. We noted that our Native American patients were less likely than others to complain of pain. A retrospective chart review of 21 Native American patients and a control group who underwent outpatient, elective laparoscopic cholecystectomy was performed. Native American patients had a statistically lower numeric pain score (mean, 6.5; 95% CI, 3.6-9.4) than non-Native American patients (mean, 8.1; 95% CI, 6.3-9.9; t38 = 2.63; P < .05). Native American patients also received less postsurgical analgesic (mean, 7.4; 95% CI, 4.0-10.8) than non-Native American patients (mean, 11.2; 95% CI, 7.2-15.2; t38 = 3.07; P < .01). Medical staff attending Native American patients should be aware that response to some scales to assess pain may not reflect accurately the degree of pain experienced.
