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The authors describe a case of a patient who has reoperated for generalized peritonitis shortly after elective inguinal hernia repair. The cause of peritonitis was small bowel diverticulosis with a ruptured diverticulum.
Our case review describes an unusual case of an acute GIT haemorrhaging, caused by multiple diverticulosis of the proximal jejunum. The disorder is rare, rarely reported in literature worldwide. The typical course of the disease is asymptomatic, manifesting itself late as acute complications, most commonly urgent abdominal disorders. Chronic symptoms are less frequent, e.g. unspecific abdominal pain or occult haemmorhage. Inspired by literature data, the authors set up their own group of patients, who had been operated by the team for diverticles located in the small intestine, in the last 9 years.
We present a patient affected of diverticular disease of the colon, with diverticulosis and two giant diverticula of the sigma, both located at the mesenteric edge. We would like to stress the low incidence of reports about this entity in the medical literature, its uncommon location and the fact of a double lesion coinciding in a single patient. We discuss the most important nosocomial aspects and the different diagnoses. Finally, we support the idea of distinguishing three different entities that in the medical literature are usually unified as a single "giant diverticulum of the colon". We reaffirm ourselves on the importance of an early diagnosis and a correct indication for surgery.
The authors report on five cases of jejuno-ileal diverticulosis, which is a rare generally fairly unimportant disease, but which may unexpectedly develop into a life-threatening situation for the patient. The Authors take these cases as their starting point for presenting a number of findings and considerations regarding various aetiopathogenetic, clinical and therapeutic aspects of the condition.
Small bowel diverticula, particularly the jejunal ones, are a rare disease with a poor and vague symptomatology. Sometimes detected by change under X-ray examinations or at surgery, they do not need any surgical treatment: only clinical and X-ray controls are required. Prophylactic resection of symptomatic low jejunal diverticula is controversial: patient's age and status will affect the indication to surgical treatment. Jejunal diverticulosis may generate serious, though not dramatic, symptoms: intestinal obstruction, inflammatory complications, haemorrhage, perforation of the diverticula are the most frequent emergencies which require an immediate surgical procedure. A clinical case is here reported.
Small bowel diverticulosis occurs in 0.3-4.4% of all autopsies. Generally the condition is clinically silent; but acute diverticulitis with peritonitis and paralytic ileus may occur in elderly people. This complication has a high mortality and its successful management requires early diagnosis and surgery.
Benign stenosis of the mid-thoracic esophagus developed in a 28-yr-old man. At operation, the esophageal wall was adherent to the surrounding tissues at the level of the stricture, and the esophageal wall appeared scarred and felt hard. Pathologic examination of the resected specimen showed many submucosal cystic spaces associated with mucosal depressions. Based on these findings, a diagnosis of esophageal intramural diverticulosis was made. However, some cystic spaces ran parallel to the long axis of the esophagus, and one had penetrated the muscular layers and led into the inflammatory mass. Muscularis mucosa surrounded the cystic spaces, and inflammation was slight. These findings suggest that the etiology of the esophageal diverticula of this case was a congenital malformation.
Clinical and bronchographic data were juxtaposed with the results of selective histological examination of the resected parts of lungs from 3 to 14-year-old children suffering for several years from persistent cough and recurrent pneumonias. The defects of small and mean bronchi branching are found in 66% of cases (out of 50) and in 64% there was diverticulosis of the mucous membrane of large and small bronchi that is followed by pseudopoliposis and the development of deep "pouches". All this is followed by bronchus-associated lymphoid tissue hyperplasia, development of peribronchial pneumonia foci, chronic bronchitis, obturation syndrome.
Three patients who presented with perforated small bowel diverticulosis were healed by resection of the perforated segment and primary anastomosis. Clinical awareness of this disease may reduce the relatively high mortality reported by most authors.
Small intestinal diverticulosis is a rare cause of abdominal pain. We report the case of a patient whose chronic intermittent abdominal pain was due to recurrent spontaneous perforation of jejunal diverticula, and who ultimately developed an acute volvulus of the small bowel, a very rarely reported association of the disorder.
In no other part of the gastrointestinal tract is there such a wide range of incidence of pathological changes and such a marked increase in incidence with increasing age as the colorectum. In view of the increasing numbers of old people in the general population, therefore, gastroenterologists are increasingly being confronted with these diseases. The most important in practical terms are constipation, colonic diverticulosis with its complications, benign and malignant tumors, and the damages to the wall of the colon resulting from deficient perfusion. In the case of geriatric patients, the evaluation of the symptomatology, so important for the diagnosis, can be difficult, since the complaints may be overemphasized owing to anxious self-observation, or, owing to a reduction in cerebral capacity, are not adequately appreciated and reported.
The authors report an unusual case of oesophageal pseudo-diverticulosis. A 63-year-old male patient presented with dysphagia. A preoperative diagnosis of oesophageal intramural tumour was made on radiological and endoscopic abnormalities. The histopathological study of the involved oesophagus showed a pseudocystic dilatation of glandular ducts in the submucosa with a lymphocytic infiltrate. The authors review the relevant literature on oesophageal intramural pseudodiverticulosis and suggest a possible pathogenesis for this rare and benign entity.
Of a total of 969 barium enemas performed over a three year period, 23 (2.4%) showed colonic diverticulosis. The mean age of the patients was 58 years and the commonest site involved was the sigmoid colon. All the patients were urbanised and were obligatory vegetarians. Six (25%) of the patients had a complication of the disease and three of them required surgery. The possible relationship of the disease with socio-economic changes is highlighted.
The authors describe results of using their original method of the operative exclusion of the colon altered by diverticulosis in 27 patients. Good immediate and remote results were noted.
The analysis of the results of treating 47 patients with complications of colonic diverticulosis was carried out. The diagnosis of the disease and its complications should be based on the strict consideration of the data of history, clinical manifestations with mandatory use of a roentgenologic method at the acute period. In perforation of diverticulum, the extraperitonization of a site of the colon is an operation of choice.
Two cases which presented with acute massive lower gastrointestinal hemorrhage from jejunal diverticulosis are reported. The various clinical presentations of this rare disease are discussed. The life-threatening complication of massive bleeding is specially outlined. The cases reported in the literature resemble the Dieulafoy ulcer lesion of the stomach.
During a 10 year period 13 patients underwent operations for complications of jejunal diverticulosis. Two had diverticulitis, 7 perforation due to inflammation, 2 haemorrhage, 1 obstruction and 1 chronic gastrointestinal symptoms due to a large solitary diverticulum. None of the patients had a correct preoperative diagnosis. Three patients were labelled psychoneurotic because investigations prior to their emergency operation failed to reveal an organic cause for their symptoms. Small bowel contrast examinations should be included in the investigation of chronic gastrointestinal symptoms of obscure origin. Two patients on follow-up developed chronic gastrointestinal symptoms which were treated successfully with broad spectrum antibiotics.
An account is given in this paper of 480 patients who had been hospitalised for colonic diverticulosis or diverticulitis in the surgical department of the Municipal Waid Hospital of Zurich, between 1970 and 1986. Laparotomy had to be performed on 219 of them (45.6 per cent), among them 84 emergency interventions. The average age of these patients was 70.7 years. Indications for emergency surgery included diffuse or locally delimited peritonitis with abscess development in 72 patients, ileus in ten cases, and massive colon haemorrhage in two. The latter two cases were handled with good success by subtotal colectomy with ileorectostomy and, one of them with the source of bleeding known, by colotomy and suturing of that source of bleeding. Sigmaincontinence resection according to Hartmann has been considered the optional approach since 1977 to diffuse peritonitis and to many cases of ileus (n = 39). In more recent time, anastomosis has been used as primary approach to some patients who survived fibrinous abdominal peritonitis (n = 4). The mortality rate associated with drainage operations according to expectation, has been clearly higher than that following resection, the comparable figures being 32.3 and 17.2 per cent. That has been attributable to non-removal of the septic focus. After all, nowadays combined antibiotic therapy is commonly used for seven to ten days for simultaneous control of both aerobic and anaerobic pathogens. This has become routine practice and involves aminoglycoside, metronidazole, and ampicillin. Overall mortality associated with emergency interventions is clearly higher than that after planned operations, the figures being 22.6 and 4.4 per cent.(ABSTRACT TRUNCATED AT 250 WORDS)