A shift in surgical management of perforated jejunal-ileal diverticulitis? Two case reports


A shift in surgical management of perforated jejunal-ileal diverticulitis? Two case reports


Wei Liu, MD1,  Ali Darehzereshki, MD1,  Michael Matsuura, MD2, Christopher You, MD2

1Department of Surgery, MedStar Health Baltimore, Baltimore, Maryland.
2Department of Surgery, MedStar Franklin Square Medical Center, Baltimore, Maryland.


Small bowel diverticular disease is usually asymptomatic, but complicated small bowel diverticular disease can present as an acute abdomen, manifesting as diverticulitis, perforation, abscess, obstruction or bleeding. Due to the rarity of the disease, very few studies have been conducted on complicated small bowel diverticular disease. Therefore, there are no clear guidelines on management. General peritonitis remains the best indication for surgical management due to its correlation with high mortality and prolonged hospital stay. Traditionally, perforated small bowel diverticular disease is managed with exploratory laparotomy, primary bowel resection and anastomosis regardless of acute presentation. However, more recent studies demonstrated a trend towards conservative or less invasive surgical management. Here, we report two perforated small bowel diverticulitis cases at our institution that underwent different management and had different outcomes.


Keywords: surgical management; perforated jejunal-ileal diverticulitis


Free Full-text PDF


How to cite this article:

Wei Liu, Ali Darehzereshki, Michael Matsuura, Christopher You. A shift in surgical management of perforated jejunal-ileal diverticulitis? Two case reports. International Journal of Case Reports, 2021; 5:219. DOI: 10.28933/ijcr-2020-10-0905


References:

1. G. A. G. C. D. C. F. G. Peters R, “Perforated di-verticulitis as a rare cause of acute abdomen.,” Eur Radiol, pp. 9:1426-8, 1999.
2. R. Kassir, “Jejuno-ileal diverticulitis: Etiopatho-genicity, diagnosis and management,” Interna-tional journal of surgery case reports, pp. 10: 151-153, 2015.
3. S. Ejaz, “Non-Meckel Small Intestine Diverticuli-tis,” Case reports in gastreoenterology, pp. 11: 462-472, 2017.
4. J. F. J. H. Woubet TK, “Complicated small-bowel diverticulosis: a case report and review of the lit-erature,” World J. Gastreoenterol, pp. 13: 2240-2242, 2007.
5. S. Krishnamurthy, “Jejunal diverticulosis. A heterogenous disorder caused by a variety of abnormalities of smooth muscle or myenteric plexus,” Gastroenterology, pp. Sep; 85(3): 538-547, 1983.
6. M. Gachabayov, “Traction diverticulum of the small bowel with enterolith as a cause of in-testinal obstruction,” Clinical medicine & re-search, pp. Dec 16(3-4): 92-94, 2018 .
7. H. Harbi, “Jejunal diverticulitis. Review and treatment algorithm,” Presse medical, pp. Dec 46 (12 Pt1): 1139-1143, 2017.
8. S. A, “Diverticular disease of the gastrointestinal tract,” Primary care, vol. 12, no. 44, pp. 643-654, 2017.
9. L. Karas, “Complicated small bowel diverticular disease: a case series,” BMJ case report, p. Apr 23, 2017.
10. G. T. S. K. R. J. Roses DF, “Perforated divertic-ula of the jejunum and ileum,” Am Surg, pp. 132:649-652, 1976.
11. M. Spasojevic, “Perforated midgut diverticulitis: revisited,” World journal of gastroenterology, pp. September 14; 18(34): 4714-4720, 2012 .
12. A. Syllaios, “Jejunal diverticulitis mimicking small bowel perforation: case report and review of the literature,” Chirurgia, pp. 113: 576-581, 2018.