tailieunhanh - Báo cáo y học: " Perforated jejunal diverticula: a case report"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Perforated jejunal diverticula: a case report. | Butler et al. Journal of Medical Case Reports 2010 4 172 http content 4 1 172 jA CASE REPORTS CASE REPORT Open Access Perforated jejunal diverticula a case report Joseph S Butler Christopher G Collins and Gerard P McEntee Abstract Introduction Jejunal diverticula are rare and are usually asymptomatic. However they may cause chronic non-specific symptoms or rarely lead to an acute presentation. Case presentation We report the case of an 82-year-old Caucasian woman presenting with a one-day history of generalized abdominal pain with three episodes of vomiting. An abdominal X-ray displayed multiple dilated loops of the small bowel. A subsequent computed tomography scan of the abdomen and pelvis revealed a thickening of the duodenum and dilatation of the proximal jejunum. Multiple small bowel diverticula were identified with surrounding pockets of free air adjacent to the jejunal diverticula suggestive of a small bowel perforation. Our patient underwent a laparotomy which identified multiple jejunal diverticula with two pinhole jejunal perforations and associated fecal contamination. The perforations were repaired with primary closure and extensive washout was performed. Conclusion Jejunal diverticulosis in the elderly can lead to significant morbidity and mortality and so should be suspected in those presenting with crampy abdominal pain and altered bowel habits. Introduction Jejunal diverticula are rare with an incidence of less than 1 . Pathologically they are pseudodiverticula of the pulsion type resulting from increased intra-luminal pressure and weakening of the bowel wall. These outpouch-ings only contain mucosa and submucosa. Despite most cases of jejunal diverticulosis remaining completely asymptomatic complications are reported in 10 to 30 of patients 2-4 . These include chronic abdominal pain malabsorption hemorrhage diverticulitis obstruction abscess formation and rarely diverticular perforation. We present