[Intestinal diverticulosis; observations in Puerto Rico].
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The authors report about their surgical experience? On the basis of one case of pneumascos and one case of gastrointestinal hemorrhage with collapse, for which no origin was found preoperatively and which was attributed to the presence of diverticula in the small bowel. The analysis of the literature shows that this rare condition (0.1% of the population) is mainly expressed as acute complications: diverticulitis, perforation, hemorrhage, obstruction. The treatment is surgical as a rule, but it can be medical if the condition is included in the scope of a malabsorption syndrome.
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Crohn's disease and diverticulitis of the sigmoid may be combined in old patients, this association could lead to difficulties in diagnosis and treatment. Three cases of Crohn's colitis associated with diverticula, two females and one male, aged between 66 and 80 years are reported by the authors. In a review of the literature, some clinical, radiological and endoscopic findings may suggest the diagnosis, which guides subsequent treatment. A high morbidity is observed after surgery. In our series, sigmoidectomy cured both Crohn's colitis and diverticulitis.
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Small bowel diverticula are usually asymptomatic and rare. Digestive bleeding is a rare complication of jejunal diverticulum whose diagnosis and treatment are difficult. We report a rare case of hematochezia whose origin was a proximal jejunal diverticulum and not determined by endoscopic investigations. Bowel resection with primary anastomosis was the chosen surgical procedure. There was no complication until discharge nor was any recurrent bleeding or functional disorder of the bowel reported during follow-up. The clinical presentation, the different value of diagnostic tools and the therapy are discussed.
The authors report the case of a patient with an unusually high number of diverticular formations (at least five), distributed along the entire duodenal tract. Following a review of the literature on this subject, the authors focus on the lack of symptoms manifested by duodenal diverticula, even if they are numerous and large in size, and on the extremely rare reports of multiple diverticula, as in this case.
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Acquired (non-Meckel's) jejuno-ileal diverticular disease is uncommon, and most surgeons have limited, if any, experience with this condition. We present an interesting case with coexistence of small bowel diverticulum and small bowel volvulus with massive abdominal distension, in which the patient had a history of abdominal distension without abdominal pain over a five-year period. A brief discussion of the common clinical features is given and the principles of treatment of jejuno-ileal diverticular disease and small bowel volvulus are presented. A 29-year- old man with no history of laparotomy was admitted with abdominal distension and abdominal compartment syndrome symptoms. An emergency laparotomy revealed 180 degree clockwise volvulus of the multiple diverticula-bearing terminal ileum. There was no diverticulum in other sites of the small intestine and colon. Additionally, there was neither adhesion nor any congenital anomalies at the other sites of the gastrointestinal system. The viability of the intestine was normal but the diameter of the ileum was extremely enlarged (approximately 20 cm). In addition, the bowel wall was also hypertrophied. The rotated and enormously enlarged diverticula-bearing small intestine was removed with cecum, and ileocolostomy was performed. The patient was discharged uneventfully from hospital on the eighth postoperative day. After the operation, all symptoms of the patient disappeared. Small bowel obstruction is a common cause of emergency surgical admission. Awareness of the fact that volvulus of the diverticula-bearing segment of the jejuno- ileum is a rare cause of small bowel obstruction may lead to earlier and prompt diagnosis and treatment.
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