Wang Li-Wen, Chen Peng, Liu Jiang, Jiang Zhi-Wei, Liu Xin-Xin
Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China.
World J Gastrointest Surg. 2023 Jun 27;15(6):1256-1261. doi: 10.4240/wjgs.v15.i6.1256.
Small bowel diverticula are rare in clinics, and small intestinal obstruction caused by coprolites is rarer and difficult to diagnose early. The true incidence of these diverticula may be underestimated due to their clinical symptoms not differing from those of small bowel obstruction resulting from other causes. It is common in the elderly, although it can occur at any age.
This is a case report of a 78-year-old man with epigastric pain for 5 d. Conservative treatment does not effectively relieve pain, inflammatory indicators are elevated, and computed tomography suggests jejunal intussusception and mild ischemic changes in the intestinal wall. Laparoscopic exploration showed that the left upper abdominal loop was slightly edematous, the jejunum mass at the near Flex ligament was palpable, the size was about 7 cm × 8 cm, the local movement was slight, and the diverticulum was seen 10 cm downward, and the local small intestine was dilated and edema. Segmentectomy was performed. After the short parenteral nutrition after surgery, the fluid and enteral nutrition solution were pumped through the jejunostomy tube, and the patient was discharged after the treatment was stable, and the jejunostomy tube was removed in an outpatient clinic one month after the operation. Postoperative pathology: Jejunectomy specimen: (1) Small intestinal diverticulum with chronic inflammation, ulcer with full-thickness activity, and necrosis of the intestinal wall in some areas; (2) also see that the hard object is consistent with stone changes; and (3) the incision margin on both sides shows chronic inflammation of mucosal tissue.
Clinically, the diagnosis of small bowel diverticulum is difficult to distinguish from jejunal intussusception. Combined with the patient's condition, rule out other possibilities after a timely disease diagnosis. According to the patient's body tolerance adopt personalized surgical methods to achieve better recovery after surgery.
小肠憩室在临床上较为罕见，由粪石引起的小肠梗阻则更为罕见且早期难以诊断。由于这些憩室的临床症状与其他原因导致的小肠梗阻并无差异，其真实发病率可能被低估。本病常见于老年人，不过任何年龄均可发病。
本文报告1例78岁男性患者，上腹部疼痛5天。保守治疗未能有效缓解疼痛，炎症指标升高，计算机断层扫描提示空肠套叠及肠壁轻度缺血改变。腹腔镜探查显示左上腹肠袢轻度水肿，可触及屈氏韧带附近的空肠肿物，大小约7 cm×8 cm，局部活动度小，向下10 cm处可见憩室，局部小肠扩张、水肿。行肠段切除术。术后短期肠外营养支持后，经空肠造瘘管泵入肠内营养制剂，病情稳定后出院，术后1个月门诊拔除空肠造瘘管。术后病理：空肠切除标本：（1）小肠憩室伴慢性炎症，溃疡全层活动，部分区域肠壁坏死；（2）可见硬物符合结石改变；（3）两侧切缘黏膜组织慢性炎症。
临床上，小肠憩室的诊断难以与空肠套叠相鉴别。结合患者病情，及时明确诊断后排除其他可能。根据患者身体耐受情况采取个体化手术方式，以实现术后更好的恢复。
