Mejri Atef, Arfaoui Khaoula, Hedfi Mohamed, Znaidi Hakim
Department of General Surgery, Jendouba Hospital, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
Department of General Surgery, Jendouba Hospital, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
Int J Surg Case Rep. 2022 May;94:107130. doi: 10.1016/j.ijscr.2022.107130. Epub 2022 Apr 28.
Jejunal divertica is a rare entity with an often clinically silent course. However, it may be associated to life-threatening complications such as perforation. Therefore it should be considered in every case of acute abdomen.
A 60-year-old female presented with a generalized abdominal pain associated with vomiting evolving for 24 h. Physical examination found an irreducible and tender hernia in the umbilical region with abdominal guarding. Laboratory test results showed a biological inflammatory syndrome. The primary diagnosis of strangulated umbilical hernia was suspected and the patient underwent an emergency laparotomy. Intra-operative examination revealed mutiple jejunal diverticula, with a perforation in one diverticulum leading to generalized peritonitis. A bowel resection and peritoneal lavage were performed with good outcome.
Jejunal diverticula is a challenging condition with various non-specific clinical presentations. Jejunal perforation is its most feared complication. Deceitful abdominal examination among elderly patients and lack of specific signs may lead to diagnostic delay responsible for high mortality rate and poor prognosis. Adjunctive imaging modalities may be needed to help establish a prompt diagnosis and dictate management strategy. Treatment of perforated jejunal diverticulum is based on limited bowel resection associated to primary anastomosis.
Jejunal diverticulitis should be kept in mind as a differential diagnosis in every case of acute abdomen. High index of clinical suspicion and eventual further radiological examinations are required to avoid misdaignosis and save patients' lives.
空肠憩室是一种罕见的疾病，其临床过程通常较为隐匿。然而，它可能与诸如穿孔等危及生命的并发症相关。因此，在每一例急腹症病例中都应考虑到它。
一名60岁女性，出现伴有呕吐的全腹疼痛，持续24小时。体格检查发现脐区有一个无法回纳且压痛的疝，伴有腹部压痛。实验室检查结果显示存在生物学炎症综合征。初步怀疑为绞窄性脐疝，患者接受了急诊剖腹手术。术中检查发现多个空肠憩室，其中一个憩室穿孔导致弥漫性腹膜炎。进行了肠切除和腹腔灌洗，结果良好。
空肠憩室是一种具有多种非特异性临床表现的具有挑战性的疾病。空肠穿孔是其最可怕的并发症。老年患者腹部检查结果具有欺骗性且缺乏特异性体征可能导致诊断延迟，从而导致高死亡率和不良预后。可能需要辅助影像学检查来帮助迅速做出诊断并确定治疗策略。空肠憩室穿孔的治疗基于有限的肠切除并进行一期吻合。
在每一例急腹症病例中，都应将空肠憩室炎作为鉴别诊断予以考虑。需要高度的临床怀疑指数以及最终进一步的影像学检查，以避免误诊并挽救患者生命。
