Tenreiro Nádia, Moreira Herculano, Silva Sílvia, Marques Rita, Monteiro Ana, Gaspar João, Oliveira António
Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508 Vila Real, Portugal.
Ann Med Surg (Lond). 2016 Feb 4;6:56-9. doi: 10.1016/j.amsu.2016.01.089. eCollection 2016 Mar.
Jejunoileal diverticulosis (JID) is a rare condition associated with nonspecific symptoms, consisting of acquired false diverticula. It frequently co-exists with colonic diverticulosis. Diagnosis is usually made incidentally or after complications. These include hemorrhage, obstruction and diverticulitis, with or without perforation.
81-year-old man presented with a painful abdominal mass in the right lower quadrant (RLQ), diffuse abdominal discomfort and fever. Abdominal examination confirmed a well-defined mass in the RLQ without rebound tenderness. Laboratory analysis revealed elevated inflammatory markers and CT scan showed a cavitated lesion with an air-fluid level in the RLQ, without evidence of intraperitoneal free air or fluid. Admitted for conservative treatment, failure to improve led to laparotomy on the 6th day of hospitalization, with identification of jejunoileal diverticulosis complicated with diverticulitis and walled-off perforation. We performed segmental enterectomy.
The incidence of JID is estimated at 0.2-7% and it is usually diagnosed in the sixth/seventh decade of life. From a diagnostic perspective, JID is a challenging disorder, without reliable diagnostic tests. Diverticulitis is the most common complication. Perforation generally causes only localized peritonitis, as involved diverticula are often walled off by the surrounding mesentery. In selected cases, medical therapy may suffice. For all other patients prompt laparotomy with segmental intestinal resection is the treatment of choice.
JID remains under diagnosed. When it presents as an acute complication it may require immediate surgical intervention. In an elderly person, especially with known gastrointestinal diverticulosis, one must have a high index of suspicion for perforation.
空回肠憩室病（JID）是一种罕见疾病，伴有非特异性症状，由后天性假性憩室组成。它常与结肠憩室病共存。诊断通常是偶然做出的，或在出现并发症后做出。这些并发症包括出血、梗阻和憩室炎，有无穿孔均可。
一名81岁男性患者，右下象限（RLQ）出现疼痛性腹部肿块、弥漫性腹部不适和发热。腹部检查证实RLQ有一个边界清晰的肿块，无反跳痛。实验室分析显示炎症标志物升高，CT扫描显示RLQ有一个有空液平面的空洞性病变，无腹腔内游离气体或液体的迹象。因保守治疗入院，病情未改善导致在住院第6天进行剖腹手术，发现空回肠憩室病合并憩室炎和包裹性穿孔。我们进行了节段性肠切除术。
JID的发病率估计为0.2 - 7%，通常在生命的第六/七十年被诊断出来。从诊断角度来看，JID是一种具有挑战性的疾病，没有可靠的诊断测试。憩室炎是最常见的并发症。穿孔通常仅引起局限性腹膜炎，因为受累的憩室通常被周围的肠系膜包裹。在某些情况下，药物治疗可能就足够了。对于所有其他患者，及时进行剖腹手术并进行节段性肠切除是首选治疗方法。
JID仍未得到充分诊断。当它表现为急性并发症时，可能需要立即进行手术干预。对于老年人，尤其是已知有胃肠道憩室病的患者，必须对穿孔有高度的怀疑指数。
