Palanivelu Chinnusamy, Rangarajan Muthukumaran, Rajapandian Subbiah, Maheshkumaar Gobi Shanmugam, Madankumar Madhupalayam Velusamy
GEM Hospital & Postgraduate Institute, 45-A, Pankaja Mill Road, Ramnathapuram, Coimbatore 641045, India.
World J Surg. 2008 Jul;32(7):1420-4; discussion 1425. doi: 10.1007/s00268-008-9469-0.
Jejunal diverticula are rare lesions, and when complications arise, they pose diagnostic difficulties. Perforation is a common complication resulting in an acute abdomen, although preoperative diagnosis is usually not possible. The "gold standard" for management for patients with complications is surgery. We present a series of patients with perforated jejunal diverticula who were on prolonged treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids for Chikungunya fever.
There were a total of six patients, all of them presenting with perforative peritonitis, with or without shock. Plain abdominal radiogram and ultrasonogram confirmed this, although the exact site of the perforation was not diagnosed preoperatively. All patients underwent exploratory laparotomy and perforated jejunal diverticulum was found. Resection and anastomosis was performed in all cases.
The mean operating time was 113.5 minutes, and the blood loss was not significant. Postoperative course was uneventful except wound infection in two patients. There was no mortality.
Prolonged NSAID and steroid use are known to cause ulceration/perforation of the upper digestive tract and colonic diverticula. This seems to be the most likely cause for the perforation of jejunal diverticula in our series of patients. This view is supported by the absence of inflammation and infiltration of neutrophils on histopathological examination of the diverticula.
空肠憩室是罕见病变，当出现并发症时，会带来诊断困难。穿孔是导致急腹症的常见并发症，尽管术前通常无法做出诊断。对于有并发症的患者，治疗的“金标准”是手术。我们报告了一系列空肠憩室穿孔患者，他们因基孔肯雅热而长期使用非甾体抗炎药（NSAIDs）和类固醇进行治疗。
共有6例患者，均表现为穿孔性腹膜炎，伴有或不伴有休克。腹部平片和超声检查证实了这一点，尽管术前未诊断出穿孔的确切部位。所有患者均接受了剖腹探查术，发现有空肠憩室穿孔。所有病例均进行了切除和吻合术。
平均手术时间为113.5分钟，失血量不多。除2例患者出现伤口感染外，术后过程顺利。无死亡病例。
已知长期使用NSAIDs和类固醇会导致上消化道和结肠憩室溃疡/穿孔。这似乎是我们系列患者中空肠憩室穿孔最可能的原因。憩室组织病理学检查未发现炎症和中性粒细胞浸润支持了这一观点。
