SMALL GUT VOLVULUS, A RARE TWIST, IN THE SETTING OF AN EVEN RARER ENTITY; MULTIPLE GIANT JEJUNO ILEAL DIVERTICULA

Authors

  • Ayesha Khan Ayub teaching hospital
  • Faheem Khan Ayub teaching hospital
  • Kashif Rafique Ayub teaching hospital
  • Sarwar Khan Ayub teaching hospital
  • Anam Majid RWJ Hospital
  • Khalid Khan Ayub teaching hospital
  • Asad Ullah Ayub teaching hospital

Abstract

Small gut volvulus with multiple Jejuno-ileal diverticulosis is an unusual pathology of the small intestine with a scarce number of cases reported so far. It usually goes unnoticed because it is often asymptomatic but complications like diverticulitis, perforation, bleeding or intestinal obstruction can occur in 10–30% of the cases. Mechanical obstruction, if it occurs, can be caused by adhesions or stenosis due to diverticulitis, intussusception at the site of the diverticulum and volvulus of the segment containing the diverticula. Acute volvulus of the small bowel is a serious abdominal emergency that poses a difficulty in diagnosis and delayed operative intervention can lead to dire consequences. We herein report the case of a 42-year-old man presented at the emergency department with acute abdominal pain, absolute constipation and vomiting. Preoperative investigations followed by laparotomy revealed small gut volvulus and multiple giant jejunal and ileal diverticula.Keywords: Small gut volvulus; small intestinal volvulus; diverticula; volvulus, jejunoileal diverticulosis, intestinal obstruction, exploratory laparotomy, acute abdomen

Author Biographies

Ayesha Khan, Ayub teaching hospital

General surgery resident, surgical A unit, Ayub teaching hospital.

Faheem Khan, Ayub teaching hospital

General surgery resident, surgical A unit, Ayub teaching hospital.

Kashif Rafique, Ayub teaching hospital

Senior Registrar, surgical A unit, Ayub teaching hospital.

Sarwar Khan, Ayub teaching hospital

General surgery resident, surgical A unit, Ayub teaching hospital.

Anam Majid, RWJ Hospital

Internist, Internal Medicine, RWJ Hospital New Jersey

Khalid Khan, Ayub teaching hospital

Head of Surgery and Allied, Ayub teaching hospital.

Asad Ullah, Ayub teaching hospital

General surgery resident, surgical A unit, Ayub teaching hospital.

References

Cabot RC, Scully RE, Mark EJ, McNeely WF, McNeely BU, Goyal RK, et al. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 25-1990: Abdominal Pain and Vomiting in a 64-Year-Old Man with Chronic Malabsorption and Diarrhea. N Engl J Med 1990;322(25):1796–806.

de Bree E, Grammatikakis J, Christodoulakis M, Tsiftsis D. The clinical significance of acquired jejunoileal diverticula. Am J Gastroenterol 1998;93(12):2523–8.

Welch GH, Anderson JR. Volvulus of small intestine in adults. World J Surg 1986;10(3):496–500.

Silen W. Acute Intestinal Obstruction. In: Harrison TR, Wilson JD, editors. Harrison's principles of internal medicine. 12th ed. Ch 244. New York: McGraw-Hill, Health Profession Division; 1991.

Roggo A, Ottinger LW. Acute small bowel volvulus in adults. A sporadic form of strangulating intestinal obstruction. Ann Surg 1992;216(2):135–41.

Feldman M, Friedman LS, Brandt LJ, editors. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia: Saunders; 2010.

Williams R, Davidson DD, Serota AL, Wilson SE. Surgical problems of diverticula of the small intestine. Surg Gynecol Obstet 1981;152(5):621–6.

Drude RB Jr, Finkelman D, Davis WD, Ferrante WA. Malabsorption in jejunal diverticulosis treated with resection of the diverticula. Dig Dis Sci 1980;25(10):802–6.

Kassahun WT, Fangmann J, Harms J, Bartels M, Hauss J. Complicated small-bowel diverticulosis: a case report and review of the literature. World J Gastroenterol 2007;13(15):2240–2.

Benya EC, Ghahremani GC, Brosnan JJ. Diverticulitis of the jejunum. Clinical and radiological features. Gastrointest Radiol 1991;16(1):24–8.

Wilcox RD, Shatney CH. Surgical implications of jejunal diverticula. South Med J 1988;81(11):1386–91.

Published

2017-01-25

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