• bariatric surgery
• biliopancreatic diversion
• complications
• duodenal diverticulitis
• transgastric endoscopy

• X-ray computed
• diverticulitis
• ileum
• perforation
• tomography
• ultrasonography

• HURF-2019-71 Hallym University Research Fund 2019

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Jejunal diverticulitis is a rare condition.

• Abdominal pain
• Computed tomography
• Jejunal diverticulitis
• Management

• Discrepancies
• Education
• Overnight
• Resident

• Bowel resection
• Emergency
• Jejunum
• Laparotomy
• Peritonitis

Acquired jejunal diverticula are relatively rare conditions. While mostly asymptomatic, they can occasionally cause life-threatening complications requiring surgical treatment. We herein report a case of hemorrhagic shock due to jejunal diverticulum with intestinal amyloidosis that was successfully managed via transcatheter arterial embolization (TAE) and surgery.

An 80-year-old female presenting with hematochezia and hemorrhagic shock was transferred to our institution. Contrast-enhanced computed tomography revealed extravasation in the small bowel around the upper jejunum. Massive transfusion was performed with subsequently planning for TAE to control bleeding followed by surgical laparotomy to evaluate the ischemic intestine. First, the second jejunal artery was selectively embolized with a 1:3 mixture of N-butyl cyanoacrylate (NBCA) and iodize oil, after which laparotomy was performed. Multiple jejunal diverticula were detected near Treitz’ ligament, and an induration of NBCA was palpable in the nearby mesentery. The intraoperative diagnosis was massive bleeding from acquired jejunal diverticula for which jejunectomy including the nearby diverticulum was performed to prevent future bleeding. Her postoperative course was stable. Histological examination of the specimen revealed several false diverticula with intestinal amyloidosis.

Hemorrhagic shock due to jejunal diverticulum with intestinal amyloidosis is extremely rare. Combined treatment of TAE and surgical laparotomy appears to be effective, because the bleeding point can be identified by palpation of the embolic material.

• Hemorrhagic shock
• Intestinal amyloidosis
• Intestinal bleeding
• Jejunal diverticula
• Transcatheter arterial embolization

• Contrast medium
• Enfermedad inmunoproliferativa de intestino delgado
• Enteritis
• Enteropatía eosinofílica
• Eosinophilic enteropathy
• Immunoproliferative small intestinal disease
• Intestino delgado
• Isquemia mesentérica
• Medio de contraste
• Mesenteric ischemia
• Multidetector computed tomography
• Small intestine
• Tomografía computarizada multidector

• jejunal diverticulitis
• perforation
• surgery

Jejunoileal diverticulitis is uncommon and poorly understood. We report a case of whole jejunoileal diverticulosis with recurrent inflammation and perforation.

A 72-year-old man with hemodialysis presented with fever and abdominal pain. The patient had a medical history of twice having jejunoileal diverticulitis. Serum testing indicated a white blood cell count of 15,670/μL and a C-reactive protein level of 10.31 mg/dL. Contrast-enhanced computed tomography showed jejunoileal diverticulosis with the concomitant mesenteric fat opacity and a 60-mm × 45-mm mass lesion containing extraluminal air bubbles. Jejunoileal partial resection was performed. Multiple diverticulosis was recognized over the entire jejunoileum, and the pouches existed along entry points of the bowel vascular supply through the mesentery. Intestinal resection was limited to the intestinal loop associated with complicated diverticulitis with abscess. Macroscopic examination revealed multiple jejunoileal diverticulosis. In the reddened mucosa, the diverticulitis and mesenteric perforation were recognized. Microscopic examination showed protrusion of mucosal and submucosal layers through a defect in the muscular layer with gangrenous inflammation. These findings supported a diagnosis of jejunoileal diverticulitis with perforation and abscess. The patient had no postoperative complications and no recurrence within 6 months.

Treatment for jejunoileal diverticulitis should be individualized for each patient according to their degree of inflammation, recurrence, and the patient's background.

Extensive diverticulosis over the entire jejunoileum is very rare. In this case, the section of the inflamed diverticulosis can be distinguished and resected to avoid a short-bowel syndrome, which should lead to an uneventful postoperative course.

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Jejunoileal diverticulitis is uncommon in clinical practice and poorly understood.

• Abscess
• Diverticulitis
• Hemodialysis
• Jejunoileum
• Perforation
• Small intestine

• Acute diverticulitis
• CT findings
• Small bowel
• Small bowel diverticulitis

• radiology
• small intestine

• Abdominal Pain/etiology
• Diverticulitis/complications
• Diverticulitis/diagnostic imaging
• Humans
• Ileum/diagnostic imaging

• Contrast medium
• Enfermedad inmunoproliferativa de intestino delgado
• Enteritis
• Enteropatía eosinofílica
• Eosinophilic enteropathy
• Immunoproliferative small intestinal disease
• Intestino delgado
• Isquemia mesentérica
• Medio de contraste
• Mesenteric ischemia
• Multidetector computed tomography
• Small intestine
• Tomografía computarizada multidector

Jejunoileal diverticulosis (JID) is a rare and nonspecific symptomatic disease. It is usually an acquired condition associated with false diverticula and integrated with colonic diverticulosis which can be diagnosed incidentally or later with complications. A sixty-nine-year-old male presented with sudden onset generalized abdominal pain. Computed tomography (CT) imaging was suggestive of ileal diverticulitis with localized perforation. The patient was treated conservatively with IV fluids and antibiotics and kept nil per orem for three days and discharged after symptoms subsided. The patient returned with a similar presentation but with a greater intensity. CT with oral contrast revealed evidence of distal ileal perforation. The terminal ileum was resected, and a double barrel ileostomy was created. Six months later, the stoma was reversed after resecting 50 cm of proximal terminal ileum which included all diverticula. The patient had a smooth postoperative recovery. Small bowel diverticulitis is generally managed conservatively unless the patient's clinical condition mandates urgent exploration. This report may add knowledge and lead to a change in clinical practice.

Duodenal obstruction is a common clinical scenario that can either be mechanical or a pseudo-obstruction. Clinical management of intestinal obstruction starts from localization and proceeds to histological examination of the stenotic intestine. Systemic factors and dysfunction of distant organs might contribute to the development of intestinal obstruction. Here, we report a unique case of idiopathic mechanical duodenal obstruction, which resolved spontaneously after 3 mo of conservative treatment, but was followed by intestinal pseudo-obstruction.

An 84-year-old woman presented with worsened postprandial vomiting accompanied by prolonged pneumonia. Thorough noninvasive investigations revealed complete circumferential stenosis in the descending duodenum without known cause. Exploratory surgery was postponed due to septic shock and possible pulmonary fungal infection. Conservative treatment for 3 mo for ileus and control of pulmonary infection resolved the intestinal obstruction completely. Unfortunately, 2 wk later, she had regurgitation and postprandial vomiting again, complicated by deteriorating wheezing and dyspnea. Computed tomography revealed a dilated stomach and proximal duodenum without new intestinal stricture or pulmonary infiltration. The patient fully recovered after combined treatment with antireflux agents, enema, prokinetics, and bronchodilators.

This complicated case highlights the inter-relationship of local and systemic contributions to ileus and gut dysfunction, which requires multidisciplinary treatment.

• Duodenal obstruction
• Pseudo-intestinal obstruction
• Pneumonia
• Airway hyperresponsiveness
• Multidisciplinary treatment
• Case report

Diverticular disease is common in the Western population and can cause considerable morbidity. The prevalence of colonic diverticulosis reaches 60% by the age of 60 years. Small bowel diverticulosis is much rarer and, when present, most commonly occurs in the duodenum. We herein report an elderly woman with jejunal diverticulosis complicated by diverticulitis and small bowel obstruction, who subsequently underwent small bowel resection and primary anastomosis. As demonstrated by this case, jejunal diverticulitis can cause serious complications and given the possibility of recurrence and serious complications, surgical options should be discussed early in the course of medical care. 

• diverticular disease
• diverticulitis
• jejunal diverticulosis
• small bowel diverticulosis
• small bowel obstruction

• Intraluminal duodenal diverticulum
• Periampullary diverticulosis
• Small bowel diverticulitis
• Small bowel diverticulosis
• Small bowel hemorrhage

• Diverticulum/diagnosis
• Diverticulum/epidemiology
• Diverticulum/etiology
• Diverticulum/therapy
• Humans
• Intestinal Diseases/diagnosis
• Intestinal Diseases/epidemiology
• Intestinal Diseases/etiology
• Intestinal Diseases/therapy
• Intestine, Small/physiopathology

• Diverticulitis
• Jejunum
• Perforation

• gastrointestinal tract
• infection
• inflammation
• molecular imaging

• Bacterial Infections/diagnostic imaging
• Bacterial Infections/microbiology
• Clostridioides difficile
• Clostridium Infections/diagnostic imaging
• Dysentery, Bacillary/diagnostic imaging
• Endoscopy
• Escherichia coli
• Escherichia coli Infections/diagnostic imaging
• Gastrointestinal Diseases/diagnostic imaging
• Gastrointestinal Tract/diagnostic imaging
• Gastrointestinal Tract/microbiology
• Humans
• Inflammation/diagnostic imaging
• Irritable Bowel Syndrome/diagnostic imaging
• Magnetic Resonance Imaging
• Molecular Imaging/methods
• Positron-Emission Tomography
• Salmonella
• Salmonella Infections/diagnostic imaging
• Sensitivity and Specificity
• Shigella
• Tomography, X-Ray Computed
• Ultrasonography

• CA12350 NCI NIH HHS
• R01 EB020125 NIBIB NIH HHS
• R01 CA205941 NCI NIH HHS
• EB020125 NIBIB NIH HHS
• CA205941 NCI NIH HHS
• R01 CA212350 NCI NIH HHS

• Bowel obstruction
• Computed tomography
• Diverticula
• Diverticular hemorrhage
• Diverticulitis
• Small bowel

• Diagnosis, Differential
• Diverticular Diseases/complications
• Diverticular Diseases/diagnostic imaging
• Humans
• Jejunal Diseases/complications
• Jejunal Diseases/diagnostic imaging
• Tomography, X-Ray Computed

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In the paper a rare case of complete and well documented jejunal diverticulitis complicated with perforation and peritonitis is described.

Jejuno-ileal diverticulitis is an uncommon, acquired clinical entity, with higher prevalence among patients aged between 60 and 70. The condition is usually silent and has been regarded as relatively innocuous. Sometimes patients complain chronic vague symptoms like malabsorption, pain or nausea, that easily lead to misdiagnosis. Acute complications are rare, however, they have been reported and can result in major surgery and high overall mortality.

We are presenting a case of a 67-year-old patient who presented to our department with abdominal pain and signs of peritonitis. The CT scan displayed an inflammatory mass with a fair amount of free liquid in the abdomen, as well as multiple diverticula at different levels of the intestine. The patient had to underwent immediate surgery, during which a resection of 25 cm jejunum and 80 cm of ileum has been performed.

Jejuno-ileal diverticula are a very uncommon finding that can present formidable challenges in diagnosis and treatment. The course can be completely asymptomatic, however, in rare cases, the condition can lead to severe complications that often require surgery. Multi detector CT (MDCT) with intravenous contrast should always be the modality of choice for investigating a suspect of small bowel diverticula. There are no specific guidelines respect the management of jejuno-ileal diverticulitis, nevertheless, in the acute setting, bowel resection is the treatment of choice.

As well as setting out the rarity of this case, our work intends to review the current literature regarding the epidemiology, natural history, diagnosis and management of jejuno-ileal diverticula

• Adhesiolisis
• Case report
• Diverticulitis
• Emergency surgery
• Jejuno-ileal diverticula
• Peritonitis