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Hans

Jejunal diverticula - Ärzteforum

Post#1 »

I would highly value your point of view in the following case:

A 85 year old woman presented with clinical signs of a mechanical small
bowel obstruction. She was operated within hours after admission and the
adhesion (appendectomy?) causing a strangulation of a terminal
ileum loop was cut down. The loop was viable and recovered within
minutes. The jejunum was distended up to a diameter of 5 cm. About 30 up
to 4cm large diverticula were found starting from the duodenaljejunal
flexure covering about 80 cm of jejunum.

My questions now are:

1. Would you resect these 80cm of jejunum in this patient in this
setting?

2. How high (or low) would you estimate the "spontaneous" risk for this
patient to experience a complication (bleeding, perforation) of jejunal
diverticula?


John Dissector

Re: Jejunal diverticula - Ärzteforum

Post#2 »

Obviously those incidentally discovered jejunal diverticula are
asymptomatic and have been present for 85 years without problem--why
meddle? All you can do is risk creating a problem where none now
exists. Obviously after 85 problem-free years the risk of something
developing during the rest of her life is extremely low--let that
risk go--if something happens, let it then be taken care of--the
overwhelming likelihood is if you do something now it is unnecessary.

User avatar
Surgeon

Re: Jejunal diverticula - Ärzteforum

Post#3 »

Warning: The following represents strictly anecdotal experience after
too many years operating on the elderly patient



1. Would you resect these 80cm of jejunum in this patient in this
setting?




No! Why add the possible morbidity of a bowel resaection to your
operation because of a theoretical concern. These diverticulae rarely
cause problems. Leave well enough alone.





2. How high (or low) would you estimate the "spontaneous" risk for this
patient to experience a complication (bleeding, perforation) of jejunal
diverticula?





One often finds these diverticulae in the elderly when operating for
something else, yet, rarely is a complication of such a diverticulum an
indication for surgery. Leave well enough alone.

Jorjo

Re: Jejunal diverticula - Ärzteforum

Post#4 »

we have a phrase "let sleeping dogs lie". I think it is applicable here

User avatar
Alalo

Re: Jejunal diverticula - Ärzteforum

Post#5 »

The answer is to do nothing in your 85 year old patient.

However I have seen these, in an eight year old child, produce acute
peritonitis mimicing appendicitis for which I did a segmental resection.
After this case I often wondered about the embryological basis for this
condition.

These diverrticula can lead to bacterial overgrowth and B12 malabsorption.

Dottore

Re: Jejunal diverticula - Ärzteforum

Post#6 »

Simple questions require simple answers.

1.- By no means...Why add more unnecessary risks?

2.- The risk of complications of the jejunal diverticulas,at 85 yo,I think must be very low indeed.

User avatar
Resident

Re: Jejunal diverticula - Ärzteforum

Post#7 »

I agree with everyone else that I would not treat these, however, for a
little different reason. I suspect these diverticula are secondary to
the long standing bowel obstructive problem and that they are highly
unlikely to cause problems now that the adhesive band is gone. I have
seen serious complications of diverticula and I don't think old age
makes you immune from these complications. However, I doubt they will
cause this particular old lady any problems.

Arizona

Re: Jejunal diverticula - Ärzteforum

Post#8 »

The interesting thing is that you are presenting a very unsual cause
of bowel obstruction in the presence of jejuno-ileal diverticulosis. The
most common cause in that population is the underlying dysmotility which
accompanies a significant number of those who have the problem.

This is a condition of acquired pulsion diverticulae that may
progress with age. I would treat them the same way as incidently found
sigmoid diverticula, leave them alone. In contrast to some of the
postings made earlier, the patient DID NOT live WITH them for 85 years.
These are acquired and are found with advancing age beyond 60-70.

Incidences of complications quoted are around 6-10%. A report went
as high as 20%. The bottom-line is that the majority will do OK without
complications.

Hans

Re: Jejunal diverticula - Ärzteforum

Post#9 »

Thank you so much for your opinions concerning the simultaneous
resection of asymptomatic jejunal diverticula! Interestingly all of you
were in favour of leaving the diverticula in peace. I did not perform
the operation myself and was against resecting the proximal jejunum
because of all the reasons most of you mentioned (unnecessary additional
risk, anastomosis delaying oral intake, no high spontaneous risk
expected etc..). The patient is doing fine nevertheless. Thanks to your
rapid response I had an impressive (international!) argument while
discussing the case with a colleague!

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