Alves Martins Bruno Augusto, Rodrigues Galletti Rosana, Marinho Dos Santos Neto Júlio, Neiva Mendes Caroline
School of Medicine, University of Brasília, Brasília, Brazil.
Unit of Surgical Clinics, Regional Hospital of Planaltina, Brasília, Brazil.
Am J Case Rep. 2018 May 10;19:549-552. doi: 10.12659/AJCR.909131.
BACKGROUND Jejunal diverticulosis is a rare clinical condition, and the majority of patients are asymptomatic. However, some patients can develop serious complications, including perforation. We report the case of a 74-year-old female patient with a perforated jejunal diverticulum who presented with an 'acute abdomen' and with pneumoperitoneum on X-ray radiography. CASE REPORT A 74-year-old female patient presented to the emergency department with a 24-hour history of acute onset of diffuse abdominal pain associated with nausea and vomiting. Physical examination showed signs of generalized peritonitis. The chest radiograph showed a pneumoperitoneum. An emergency laparotomy was performed, and a perforated jejunal diverticulum was identified. Resection of the involved jejunal segment and a primary jejunal anastomosis were performed. CONCLUSIONS Perforated jejunoileal diverticula should be included in the differential diagnosis for elderly patients who present with an acute abdomen. A delay in the diagnosis can be fatal in this group of patients. Although radiographic signs, such as pneumoperitoneum, are unusual in these cases, this finding should provide a diagnostic clue for the physician.
背景 空肠憩室病是一种罕见的临床病症，大多数患者无症状。然而，一些患者可能会出现严重并发症，包括穿孔。我们报告一例74岁女性患者，患有空肠憩室穿孔，表现为“急腹症”，X线检查显示有气腹。病例报告 一名74岁女性患者因突发弥漫性腹痛24小时伴恶心、呕吐就诊于急诊科。体格检查显示有弥漫性腹膜炎体征。胸部X线片显示有气腹。进行了急诊剖腹手术，发现一个空肠憩室穿孔。切除受累的空肠段并进行了空肠一期吻合术。结论 空回肠憩室穿孔应纳入老年急腹症患者的鉴别诊断。对这组患者诊断延迟可能是致命的。尽管在这些病例中，气腹等影像学征象并不常见，但这一发现应为医生提供诊断线索。
