Shiratori Hiroshi, Nishikawa Takeshi, Shintani Yukako, Murono Koji, Sasaki Kazuhito, Yasuda Koji, Otani Kensuke, Tanaka Toshiaki, Kiyomatsu Tomomichi, Hata Keisuke, Kawai Kazushige, Nozawa Hiroaki, Ishihara Soichiro, Fukayama Masashi, Watanabe Toshiaki
Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, 3-1 Hongo 7-chome, Bunkyo-ku, Tokyo, 113-8655, Japan.
Department of Pathology, The University of Tokyo, 3-1 Hongo 7-chome, Bunkyo-ku, Tokyo, 113-8655, Japan.
Clin J Gastroenterol. 2017 Apr;10(2):137-141. doi: 10.1007/s12328-017-0712-9. Epub 2017 Jan 19.
Perforation of jejunal diverticulum is a rare complication. Here, we report a case of jejunal diverticulum penetration with surrounding ectopic pancreas. An 83-year-old female patient was admitted to our department with acute onset of severe abdominal pain lasting for half a day. Abdominal computed tomography showed outpouching of the small intestine that contained air/fluid, with multiple surrounding air bubbles in the mesentery of the small intestine. She was diagnosed with penetration of the small intestine, and an emergency laparotomy was indicated. The penetrated jejunal diverticulum was identified ~20-cm distal to the ligament of Treitz. Partial resection of the jejunum was performed, and her postoperative course was uneventful. The pathological findings confirmed diverticulum penetration into the mesentery and severe inflammation at the site, with surrounding ectopic pancreas. Furthermore, the pancreatic ducts were opened through the penetrated diverticulum. This rare case shows that the ectopic pancreas might have caused penetration of jejunal diverticulum owing to the pancreatic duct opening through the diverticulum.
空肠憩室穿孔是一种罕见的并发症。在此,我们报告一例空肠憩室穿孔伴周围异位胰腺的病例。一名83岁女性患者因突发严重腹痛半天入院。腹部计算机断层扫描显示小肠有含气/液的袋状突出,小肠系膜周围有多个气泡。她被诊断为小肠穿孔,遂行急诊剖腹手术。在距Treitz韧带约20厘米处发现穿孔的空肠憩室。行空肠部分切除术,术后恢复顺利。病理结果证实憩室穿入系膜且该部位有严重炎症,周围有异位胰腺。此外,胰管通过穿孔的憩室开放。这一罕见病例表明,由于胰管通过憩室开放,异位胰腺可能导致了空肠憩室穿孔。