The Use of Computed Tomography in the Diagnosis of Jejunal Diverticulosis Complicated by Diverticulitis and Intestinal Bleeding
https://doi.org/10.20862/0042-4676-2022-103-1-3-62-68
Abstract
The jejunal diverticulosis is rare and accounts for approximately 0.5–1 % of the general population. Diagnosis of the pathology is difficult even in the presence of symptomatic complications (perforation, abscess, peritonitis, sepsis, intestinal obstruction and bleeding), therefore, it is often overlooked or delayed, which requires high awareness and vigilance of physicians. Emergency surgical interventions are performed due to the lack of clear clinical symptoms and reliable radiological data in an average of 25 % of patients with complications of diverticulosis. In the presented case, multislice computed tomography (MSCT) with intravenous contrasting revealed multiple diverticula of the jejunum with reactively altered walls, infiltration of the adjacent cellular tissue and small gas inclusions, indicating diverticulum microperforation. Esophagogastroduodenoscopy (EGD) was performed which confirmed the jejunum bleeding, and was followed by laparotomy which confirmed multiple jejunal diverticula with microperforation and bleeding. Thus, timely MSCT in combination with EGD allowed to avoid complications of jejunal diverticulitis.
About the Authors
V. K. LabutinRussian Federation
Vladislav K. Labutin, Radiologist
121374
Mozhayskoye shosse, 14
Moscow
M. V. Rostovtsev
Russian Federation
Mikhail V. Rostovtsev, Dr. Med. Sc., Head of Department
Department of Radiation Diagnostics
121374
Mozhayskoye shosse, 14
Moscow
N. V. Nudnov
Russian Federation
Nikolay V. Nudnov, Dr. Med. Sc., Deputy Director for Science, Head of Department, Professor
Research Department of Complex Diagnostics and Radiotherapy
117997
ul. Profsoyuznaya, 86
125993
Chair of Radiology
ul. Barrikadnaya, 2/1, str. 1
Chair of Oncology and Radiology
117198
ul. Miklukho-Maklaya, 6
Moscow
V. M. Nadaraya
Russian Federation
Viktor M. Nadaraya, Cand. Med. Sc., Chief Physician
121374
Mozhayskoye shosse, 14
Moscow
M. A. Godzhello
Russian Federation
Mikhail A. Godzhello, Cand. Med. Sc., Head of Department
Surgical Department of Radiation Diagnostics
121374
Mozhayskoye shosse, 14
Moscow
I. V. Litvinenko
Russian Federation
Iya V. Litvinenko, Cand. Med. Sc., Radiologist
121374
Mozhayskoye shosse, 14
Moscow
T. A. Nikonorova
Russian Federation
Tatiana A. Nikonorova, Radiologist
121374
Mozhayskoye shosse, 14
Moscow
V. O. Vorob’eva
Russian Federation
Valentina O. Vorob’eva, Clinical Resident
Radiology
117997
ul. Profsoyuznaya, 86
Moscow
References
1. Kumar D., Meenakshi. Complicated jejunal diverticulitis with unusual presentation. Radiol Case Rep. 2017; 13 (1): 58–64. http://doi.org/10.1016/j.radcr.2017.10.002.
2. Осадчук М. А. Дивертикулярная болезнь толстой кишки: эпидемия 21 века / М. А. Осадчук, А. А. Свистунов // Поликлиника. – 2014. – S1: 10–6. [Osadchuk M. A., Svistunov A. A. Diverticular colon disease: an epidemic of the 21st century. Poliklinika / Polyclinic. 2014; S1: 10–6 (in Russ).]
3. Makarawo T. P., Eichenauer S., Shah U., et al. Surgery for diverticulitis: a re-evaluation of the changing trends. Int Surg. 2014; 99 (4): 364–70. http://doi.org/10.9738/INTSURG-D-13-00067.1.
4. Vennix S., Morton D. G., Hahnloser D., et al. Systematic review of evidence and consensus on diverticulitis: an analysis of national and international guidelines. Colorectal Dis. 2014; 16 (11): 866–78. http://doi.org/10.1111/codi.12659.
5. Kassahun W. T., Fangmann J., Harms J., et al. Complicated small-bowel diverticulosis: a case report and review of the literature. World J Gastroenterol. 2007; 13 (15): 2240–2. URL: https://pubmed.ncbi.nlm.nih.gov/17465510/
6. Leigh N., Sullivan B. J., Anteby R., Talbert S. Perforated jejunal diverticulitis: a rare but important differential in the acute abdomen. Surg Case Rep. 2020; 6 (1): 162. http://doi.org/10.1186/s40792-020-00929-3.
7. Sarıtaş A. G., Topal U., Eray İ. C., et al. Jejunal diverticulosis complicated with perforation: a rare acute abdomen etiology. Int J Surg Case Rep. 2019; 63: 101–3. http://doi.org/10.1016/j.ijscr.2019.09.013.
8. Macari M., Faust M., Liang H., Pachter H. L. CT of jejunal diverticulitis: imaging findings, differential diagnosis, and clinical management. Clin Radiol. 2007; 62 (1): 73–7. http://doi.org/10.1016/j.crad.2006.09.014.
9. Koh F. J., Khor J. L., Chew M. H. An unusual case of giant ileal diverticulum – a case report. Int J Surg Case Rep. 2017; 41; 277–9. http://doi.org/10.1016/j.ijscr.2017.10.056.
10. Шило Р. С. Осложнения дивертикулов тонкой кишки, случаи из практики / Р. С. Шило [и др.] // Журнал Гродненского государственного медицинского университета. – 2019. – 17(2): 219–23. http://doi.org/10.25298/2221-8785-2019-17-2-219-223. [Shyla R. S., Mahiliavets E. V., Belyuk K. S., et al. Complications of small intestine diverticula, cases from clinical practice. Journal of the Grodno State Medical University. 2019; 17 (2): 219–23 (in Russ). http://doi.org/10.25298/2221-8785-2019-17-2-219-223 ]
11. Ардатская М. Д. Дивертикулярная болезнь / М. Д. Ардатская [и др.] // Колопроктология. – 2021. – 20 (3): 10–27. http://doi.org/10.33878/2073-7556-2021-20-3-10-27. [Ardatskaya M. D., Achkasov S. I., Veselov V. V., et al. Diverticular disease. Coloproctology. 2021; 20 (3): 10–27 (in Russ). http://doi.org/10.33878/2073-7556-2021-20-3-10-27 ]
12. Rajaguru K., Sheong S. C. Case report on a rare cause of small bowel perforation perforated ileal diverticulum. Int J Surg Case Rep. 2021; 87: 106465. http://doi.org/10.1016/j.ijscr.2021.106465.
13. Nonose R., Valenciano J. S., de Souza Lima J. S., et al. Jejunal diverticular perforation due to enterolith. Case Rep Gastroenterol. 2011; 5 (2): 445–51. http://doi.org/10.1159/000330842.
14. Welbourn H. L., Hartley J. E. Management of acute diverticulitis and its complications. Indian J Surg. 2014; 76 (6): 429–35. http://doi.org/10.1007/s12262-014-1086-6.
15. Longo W. E., Vernava A. M. 3rd. Clinical implications of jejunoileal diverticular disease. Dis Colon Rectum. 1992; 35 (4): 381–8. http://doi.org/10.1007/BF02048119.
16. Myers E., Hurley M., O’Sullivan G. C. Laparoscopic peritoneal lavage for generalized peritonitis due to perforated diverticulitis. J Br Surg. 2008; 95 (1): 97–101. http://doi.org/10.1002/bjs.6024.
17. Ramistella A. M., Brenna M., Fasolini F., De Monti M. Jejuno-ileal diverticulitis: a disorder not to underestimate. Int J Surg Case Rep. 2019; 58: 81–4. http://doi.org/10.1016/j.ijscr.2019.04.015.
18. Igwe P. O., Ray-Offor E., Allison A. B., Alufohai E. F. Volvulus complicating jejunal diverticulosis: a case report. Int J Surg Case Rep. 2019; 9: 61–4. http://doi.org/10.1016/j.ijscr.2015.02.017.
19. Chow D. C., Babaian M., Taubin H. L. Jejunoileal diverticula. Gastroenterologist. 1997; 5 (1): 78–84.
20. Köhler L., Sauerland S., Neugebauer E. Diagnosis and treatment of diverticular disease: results of a consensus development conference. The Scientific Committee of the European Association for Endoscopic Surgery. Surg Endosc. 1999; 13 (4): 430–6. http://doi.org/10.1007/s004649901007.
21. Horesh N., Klang E., Gravetz A., et al. Jejunal diverticulitis. J Laparoendosc Adv Surg Tech A. 2016; 26 (8): 596–9. http://doi.org/10.1089/lap.2016.0066.
Review
For citations:
Labutin V.K., Rostovtsev M.V., Nudnov N.V., Nadaraya V.M., Godzhello M.A., Litvinenko I.V., Nikonorova T.A., Vorob’eva V.O. The Use of Computed Tomography in the Diagnosis of Jejunal Diverticulosis Complicated by Diverticulitis and Intestinal Bleeding. Journal of radiology and nuclear medicine. 2022;103(1-3):62-68. (In Russ.) https://doi.org/10.20862/0042-4676-2022-103-1-3-62-68