Intestinal stenosis can be caused by sizeable diverticulum which may apply pressure to the adjacent bowel wall, as was the case with our patient. Ten to 20% present with acute abdomen due to development of complications such as diverticulitis, fistula formation, GI hemorrhage, perforation and obstruction. showed the incidence of different presentations to be as follows: abdominal pain 64%, chronic obstruction 10-25%, GI bleeding 15%, malabsorption 3.5-12% and perforation 2%. Majority of people with SBD are asymptomatic or have minor, non-specific gastro-intestinal symptoms, and found incidentally on imaging studies or surgery performed for unrelated causes. Clinical aspects of this entity are variable. The most widely accepted theory is that irregular intestinal contractions generate increased segmental intra-luminal pressure, favoring the formation of diverticula. The etiology of this entity remains unknown. Small bowel diverticulosis (SBD) represents an uncommon pathology. The patient´s post-operative course was uneventful and over three months she gained up to 15kg. A resection of diseased segment of jejunum, the third and fourth portions of duodenum with a duodeno-jejunal latero-terminal anastomosis were carried out. Upon exploration, we found diffuse jejunal diverticula reaching duodenum ( Figure 2). The abdominal computed tomography (CT) demonstrated distended proximal small bowel loops with multiple diverticula, of them one was paraduodenal, giant measured 9cm*8cm*6.5cm and exerts a compression effect over the inferior duodenal angle ( Figure 1). Upper gastrointestinal endoscopy showed multiple duodenal diverticuli, a distension of the 1 st and 2 nd parts of the duodenum with stomach stasis. Abnormal laboratory findings included anemia (haemoglobin-10.9g/dl MCV 87fL), hypoalbuminemia (28g/l) and hypocholesterolaemia (total cholesterol 2.2mmol/l). Abdominal exam revealed an obvious fasting lapping without palpable mass or other abnormalities. At physical exam, her body mass index was 17.9kg/m². She was operated in July 2016 for a left crural hernia. Ī 51-year-old woman, without a medical family history, was admitted to the hepato-gastro-enterology department in late December 2016 with a 6-month history of delayed post-prandial vomiting and significant weight loss (about 20kg in three months). Diverticular disease of the small bowel: a rare cause of the duodenojejunal flexure obstruction (a case report). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Ĭite this article: Arwa Guediche et al. Keywords: Diverticula, small intestine, gastrointestinal obstruction, case report For those having TSF and synchronous metastatic disease enable to resection, subtotal colectomy should be recommended.Case report | Volume 38, Article 213, | 10.11604/pamj.2021.38.213.27575 Diverticular disease of the small bowel: a rare cause of the duodenojejunal flexure obstruction (a case report) Arwa Guediche, Soumaya Ben Amor, Walid Mnari, Mabrouk Abdelaali, Waad Farhat, Houcem Ammar, Mohamed Amine Said, Mejda Zakhama, Wided Bouhlel, Om keltoum Sellem, Nabil Ben Chaabene, Mondher Golli, Ali Ben Ali, Leila SaferĬorresponding author: Arwa Guediche, Gastroenterology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia ConclusionĮlective subtotal colectomy for TSF allows to discover distant positive LNs in nearly 10% of patients. The presence of synchronous metastases was predictor of metastatic distant LNs ( P = 0.042). These patients had a significantly advanced stage and more positive LNs than the others (stage III-IV: 100% vs 22%, P = 0.0009 and 6 vs 0, P < 0.0001, respectively). All these patients had a positive distant LN along the right colic artery. Among them, six (33% of pN+ patients and 9% of the series) had at least one positive distant LN. The median number of LNs examined was 20. At pathological analysis, LNs were classified into two groups: locoregional LN (along the left colic artery) and distant LN (along the middle colic, right colic, and ileocolic arteries). Methodīetween 20, 65 patients were included. We aimed to detail the anatomical distribution of metastatic LNs in patients undergoing elective subtotal colectomy for TSF. Tumors of the splenic flexure (TSF) can be associated with metastatic lymph nodes (LN) along the left colic pedicle, but also along the superior mesenteric vessels.
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