Acquired Jejunoileal Diverticulosis and Its Complications: A Review of the Literature

Abstract

Jejunoileal diverticulosis is a rare entity. Jejunoileal diverticulosis is not a disease that surgeons see often in clinical practice; however, it should remain on the differential diagnosis for any patient with an acute abdomen or gastrointestinal bleeding of unknown origin. It can present with a wide range of clinical scenarios and when patients experience chronic symptoms such as bloating, abdominal pain, nausea, bacterial overgrowth, or malabsorption, medical therapy is successful in most patients. However, when patients present with acute symptoms of bleeding, inflammation, perforation, or obstruction, surgical resection and primary anastomosis is often the treatment of choice. If patients are asymptomatic, they are better left alone, even when discovered incidentally in the operating room. In closing, the possibility of a patient having jejunal diverticular disease should be suspected whenever the symptoms of obscure abdominal pain, anemia, dilated jejunal loops on abdominal radiographs, a history of colonic diverticuli, and a history of acute appendicitis.

Emergency surgery for jejunal diverticulosis: our experience and review of literature

“…Fortunately, the incidence of associated complications requiring surgical intervention remains low 4 . The most common acute complications that mandate immediate surgery include perforation, massive gastrointestinal bleeding and intestinal obstruction 5 …”

“…Patients with perforated diverticulitis often present with localized or diffuse peritonitis. Some of the factors responsible for the perforation have been attributed to a necrotizing inflammatory reaction, blunt trauma and foreign body impaction 3–5 . In the acute setting, the principles of management must be targeted towards achieving early diagnosis and limiting further contamination through timely surgery.…”

“…The basic principles of the laparotomy must be to limit further contamination, copious lavage and resection of the diseased segment. Though less invasive treatments such as invagination, local excision and percutaneous drainage have been mentioned, their results are abysmal 5,7 . The outcome of patients following acute perforation is often dismal with mortality of up to 40% reported 7,8 …”

“…Should surgery be necessary, some of the techniques specifically described in managing enterolith obstruction included milking it to the colon or an enterotomy 5 . Surgical resection is required if the aforementioned techniques failed or when the causation of the intestinal obstruction is due to the other mechanical pathologies as described earlier.…”

Perforated Jejunal Diverticulum Treated by Exteriorization in An Adult Patient with Alcoholic Psychosis: A Case Report

“…Although jejunal diverticulum is usually asymptomatic, it may cause abdominal pain, nausea, vomiting, and malabsorption. It may also lead to acute fetal complications, such as perforation, intestinal hemorrhage, and obstruction [4] . We herein report a rare surgical case of perforated jejunal diverticulum due to small bowel obstruction in an adult patient with alcoholic psychosis and dementia.…”