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.     

Paraduodenal hernia and jejunal diverticulosis

A case of left-sided paraduodenal hernia and jejunal diverticulosis is described in 75-year-old man who presented with chronic intermittent abdominal pain, weight loss, and anemia. A brief review of the epidemiology, pathogenesis, and clinical presentation displays the variety of symptoms associated with these rare conditions.     

Asymptomatic multiple duodenal diverticulosis. A rare case report

The authors report the case of a patient with an unusually high number of diverticular formations (at least five), distributed along the entire duodenal tract. Following a review of the literature on this subject, the authors focus on the lack of symptoms manifested by duodenal diverticula, even if they are numerous and large in size, and on the extremely rare reports of multiple diverticula, as in this case.     

Celiac disease and multiple jejunal diverticulosis

Summary A 60-year-old woman with diarrhea, weight loss, steatorrhea, and anemia was found to have multiple jejunal diverticula and a flat jejunal mucosa on peroral biopsy. Serial metabolic studies and multiple jejunal biopsies conducted during a 40-day period of gluten withdrawal showed a decrease in steatorrhea, a return toward normal of mucosal lipid distribution, and focal improvement in the morphology of the jejunal surface epithelium. During gluten read-ministration, fecal fat excretion increased and the distribution of lipid droplets in the jejunal mucosa again became abnormal. The administration of an antibiotic for 16 days had no effect on the clinical, biochemical, or histologic abnormalities. The results suggest that the malabsorption was attributable to celiac disease and not to the jejunal diverticulosis.Supported in part by Grants FR-00044 from the Division of Research Facilities and HE-06089 from the National Institutes of Health, U. S. Public Health Service.Serum Vitamin B₁₂ and folate determinations were performed by Dr. Frederick A. Klipstein, Columbia University College of Physicians and Surgeons, New York, N. Y., and total lipid assays by Bio-Science Laboratories, Los Angeles, Calif.     

A case of enterolith small bowel obstruction and jejunal diverticulosis

We reported a case of 79-year old woman with known large bowel diverticulosis presenting with small bowel obstruction due to stone impaction - found on plain abdominal X-ray. Contrast studies demonstrated small bowel diverticulosis. At laparotomy, the gall bladder was normal with no stones and no abnormal communication with small bowel - excluding the possibility of a gallstone ileus. Analysis of the stone revealed a composition of bile pigments and calcium oxalate. This was a rare case of small bowel obstruction due to enterolith formation - made distinctive by calcification (previously unreported in the proximal small bowel).     

Digestive tract hemorrhage secondary to jejunal angiodysplasia associated with jejunal diverticulosis

The most important factor in the management of alimentary tract bleeding is the adequate localization of the lesion. Small bowel bleeding is a rare entity and determination of the specific anatomic site is difficult. Once stomach, duodenum, or colon origin has been discharged through endoscopy, methods such as angiography and Tc99m RBC scans are appropriate. We present a patient with lower gastrointestinal bleeding secondary to jejunal angiodysplasia associated with jejunal diverticular disease. In the present case, Tc99m RBC scans were used to identify the bleeding site. In cases of lower gastrointestinal bleeding of undetermined origin, we suggest the consideration of both diagnoses (angiodysplasia or diverticular disease) with exploratory celiotomy to resolve these pathologies, particularly in the elderly patient.     

Acute massive gastrointestinal hemorrhage in jejunal diverticulosis

Two cases which presented with acute massive lower gastrointestinal hemorrhage from jejunal diverticulosis are reported. The various clinical presentations of this rare disease are discussed. The life-threatening complication of massive bleeding is specially outlined. The cases reported in the literature resemble the Dieulafoy ulcer lesion of the stomach.     

Digestive bleeding and acute abdomen caused by jejunal diverticulosis. Case report

We present a patient with acute abdomen and digestive bleeding caused by jejunal diverticulosis. Jejunal diverticulosis, mainly asymptomatic, when is symptomatic have a wide clinical spectrum, ranging from chronic anemic syndrome to acute abdomen. In this communication, we reviewed the clinical presentation, the pathogenesis and the treatment this infrequent pathology.     

Reversible nicotinamide-deficiency encephalopathy in a patient with jejunal diverticulosis

A patient with severe malabsorption due to massive diverticulosis of the small intestine developed an acute encephalopathic syndrome which responded dramatically to intravenous nicotinamide. Various mechanisms are discussed whereby nicotinamide deficiency might have occurred in this clinical context.     

Malabsorption in jejunal diverticulosis treated with resection of the diverticula

Patients with jejunal diverticula usually are asymptomatic unless bacterial overgrowth within the diverticula is sufficient to cause vitamin B12 deficiency, by direct uptake of the vitamin by the bacteria, or malabsorption resulting from bacterial deconjugation of bile salts and impaired lipid digestion. The administration of broad-spectrum antibiotics usually constitutes effective treatment that suppresses bacterial flora, with surgery reserved for complications such as hemorrhage, perforation, and abscess formation, and acute or chronic intestinal obstruction. Our patient had many diverticula, and two courses of antibiotics failed to provide prolonged relief of symptoms. After surgical exploration to exclude the presence of partial intestinal obstruction or infiltrating disease of the terminal ileum, the segment of jejunum bearing diverticula was resected. Since operation the patient has remained asymptomatic, which suggests that in certain patients, even with many diverticula, surgical exploration and excision of the diverticula may be curative.     

A rare complication of coronary arteriography

We describe a 66-year-old man with acute mesenteric ischemia and myocardial ischemia within 6 hr after coronary arteriography. He underwent successful emergency surgery with embolectomy of the mesenteric artery and coronary artery bypass grafting. Cathet. Cardiovasc. Diagn. 43:455–456, 1998. © 1998 Wiley-Liss, Inc.