Jejunal diverticulosis and gastrointestinal bleeding

Occult gastrointestinal bleeding frequently frustrates clinicians' attempts to locate the source. Foci of hemorrhage within the small bowel are often found only at laparotomy and can be attributed to Meckel's diverticula, carcinomas, or less frequently, pulsion-type diverticula. We report our experience with two patients whose jejunal diverticula resulted in recurrent episodes of massive gastrointestinal hemorrhage.     

Jejunal diverticulosis: a potentially dangerous entity

Although jejunal diverticulosis is a rare entity and usually asymptomatic, it may cause chronic symptoms and acute complications. Because of the rarity of the entity, diagnosis is often delayed, resulting in unnecessary morbidity and mortality. The purpose of this study was to draw attention to jejunal diverticula and their complications. The medical records of 8 consecutive patients with complications due to small-bowel diverticula treated at our department during the past 4 years were reviewed. All diverticula were located in the jejunum. Seven patients had acute complications, 3 patients had an intra-abdominal abscess, 2 had free perforation with diffuse peritonitis, 1 had a bowel occlusion and 1 patient had concomitant bleeding and occlusion. One patient presented with chronic symptoms. A preoperative diagnosis of jejunal diverticula, before explorative laparotomy, was not reached in any of the 7 patients with acute symptoms. In the patient with chronic symptoms, multiple jejunal diverticula complicated by a jejuno-colic fistula and foreign body were found at laparotomy. On patient died of multiorgan failure. Small-bowel diverticulosis is a rare entity, but it should not be regarded as a clinically insignificant finding. It may be difficult to make a preoperative diagnosis. Patients with incidentally detected proximal jejunal diverticula, at imaging studies or at laparotomy, warrant close observation and awareness that the diverticula may cause serious complications.     

Jejunal diverticulosis: a potentially dangerous entity

Although jejunal diverticulosis is a rare entity and usually asymptomatic, it may cause chronic symptoms and acute complications. Because of the rarity of the entity, diagnosis is often delayed, resulting in unnecessary morbidity and mortality. The purpose of this study was to draw attention to jejunal diverticula and their complications. The medical records of 8 consecutive patients with complications due to small‐bowel diverticula treated at our department during the past 4 years were reviewed. All diverticula were located in the jejunum. Seven patients had acute complications, 3 patients had an intra‐abdominal abscess, 2 had free perforation with diffuse peritonitis, 1 had a bowel occlusion and 1 patient had concomitant bleeding and occlusion. One patient presented with chronic symptoms. A preoperative diagnosis of jejunal diverticula, before explorative laparotomy, was not reached in any of the 7 patients with acute symptoms. In the patient with chronic symptoms, multiple jejunal diverticula complicated by a jejuno‐colic fistula and foreign body were found at laparotomy. On patient died of multiorgan failure. Small‐bowel diverticulosis is a rare entity, but it should not be regarded as a clinically insignificant finding. It may be difficult to make a preoperative diagnosis. Patients with incidentally detected proximal jejunal diverticula, at imaging studies or at laparotomy, warrant close observation and awareness that the diverticula may cause serious complications.     

Jejunal diverticulosis with perforation as a complication of Fabry's disease

This study presents the case of a patient who had jejunal diverticulosis with perforation and abscess formation as a complication of Fabry's disease. Light microscopy disclosed glycolipid deposition in the neurons and nerve fibers of the intestinal nerve plexuses and smooth muscle. Silver stains of the myenteric plexus in the involved segment of the bowel showed enlarged, granular argyrophobic neurons and a marked decrease in the number of argyrophilic neurons, with those remaining being enlarged and distorted by the cytoplasmic glycolipid accumulation. These abnormalities of the myenteric plexus suggest that jejunal diverticulosis may be the result of a variety of disorders of the smooth muscle or myenteric plexus, or both. We propose that jejunal diverticulosis in our patient was a consequence of uncoordinated smooth muscle activity resulting from Fabry's involvement of myenteric plexus neurons, with mucosal protrusion through the smooth muscle.     

Jejunal leiomyosarcoma presenting as chronic intra-abdominal abscess.

We report a 35-year-old man with jejunal leiomyosarcoma who presented with chronic intra-abdominal abscess. He underwent drainage of the abscess initially but was re-explored four months later when a mass developed. Total excision of the tumor was done.     

Intramural esophageal diverticulosis.

An investigation of the formal patho-genesis of the so-called intramural esophagus diverticulosis is carried out on a case confirmed by autopsy. The roentgenological diagnosis corresponded morphologically with a proliferation of sub-mucous esophagus glands and a dilatation of their outlets, a portion of which displayed platelet epithelial metaplasia. Diverticle formation is feigned by widening, predominantly of the outlets, which could be traced into the muscular wall layers. In the present case esophagitis with attendant inflammation along the outlets lead to fistula formation into the anterior mediastinum with attendant mediastinitis. Aspirations were due to constrictions of the esophagus lumen. The patient came to exitus as a result of purulent abscessing aspiration pneumonia complicated by pulmonary artery emboli.     

Jejunal carcinoma.

We report here the case of a patient with jejunal adenocarcinoma who presented with features of upper gut obstruction and was diagnosed post-operatively on histology.     

Jejunal diverticulosis is not always a silent spectator： A report of 4 cases and review of the literature

Jejunal diverticulosis （JD） is a rare clinical entity. The potential complications of this condition are discussed here through a series of cases presented to our centre. A retrospective analysis of four cases, which were diagnosed and treated, was performed. These included two cases of gastrointestinal haemorrhage, one case of perforation and one case of enterolith obstruction. All of these cases were secondary to jejunal diverticulosis and treated surgically. This was accompanied by a literature search to identify the different modalities for diagnosis and treatment of this condition. JD is rare and may lead to a diagnostic delay. Awareness of the wide spectrum of potential complications can prevent this delay.     

Jejunal monosaccharide, water, and electrolyte transport in patients with chronic pancreatitis.

Jejunal perfusion studies were performed to assess water, electrolyte, d-xylose, and d-glucose transport in 16 patients with chronic calcific pancreatitis (eight with and eight without steatorrhoea) and in 10 control subjects. The patients with steatorrhoea demonstrated significantly less xylose, water, and electrolyte absorption than patients without steatorrhoea and control subjects, when an isosmotic slaine-xylose solution was perfused. On the other hand, when an isosmotic saline-glucose solution was perfused, the patients with steatorrhoea absorbed significantly more glucose, water, and electrolytes than control subjects. Significant correlation was demonstrated between the absorption of xylose as measured by the segmental perfusion technique and the peak serum xylose level during perfusion as well as the five-hour urinary xylose excretion after a 25 g oral dose of xylose. The xylose absorption measured by small bowel perfusion also correlated significantly with pancreatic juice amylase and trypsin concentrations obtained during a standard pancreatic function test.     

人工气腹治疗慢性阻塞性肺气肿临床观察

目的观察人工气腹治疗慢性阻塞性肺气肿（慢阻肺）的疗效。方法对210例慢阻肺患者进行人工气腹治疗,并对其治疗前后的肺功能进行评估。结果与治疗前相比,治疗后患者的用力肺活量（FVC）、最大通气量（MVV）、一秒钟用力呼气率（FEV1%）、6分钟行走距离（6MWD）均有明显改善（P〈0．01）。结论人工气腹治疗慢阻肺可有效改善患者肺功能。     

Diagnostic pneumoperitoneum.

Pneumoperitoneum as a diagnostic procedure has been practised for many years but there is a reluctance to make use of it. The author believes that this is due in some degree to lack of clearly defined indications and partly to lack of confidence in the safety of the procedure. In this paper the technique of diagnostic pneumoperitoneum is described and the risks are examined. Indications for its use are described. Finally, three case histories of special relevance are described and a summary of the results is tabulated with a view of giving an estimate of the diagnostic value which may be expected.     

Jejunal water and sodium secretion occurs in chronic idiopathic intestinal pseudo-obstruction

We observed jejunal water and sodium secretion in two patients with chronic idiopathic intestinal pseudo-obstruction by standard perfusion techniques. The ability of glucose to reverse this secretory state was impaired. These observations suggest that a jejunal secretory state may contribute to the diarrhea in chronic idiopathic intestinal pseudo-obstruction.     

Enterolith ileus complicating jejunal diverticulosis.

Small intestinal obstruction caused by enteroliths originating in jejunal diverticula is rare. We present our experience with three elderly female patients who were successfully treated for this condition. The diagnosis, in all three cases, was made on laparotomy. Two patients underwent enterolithotomy while the third, who had a acutely inflamed jejunal diverticulum, had a jejunal resection.