Jejunoileal Diverticulosis has Heterogeneous Pathophysiology and Requires Special Consideration During Treatment
Yıl: 2018 Cilt: 28 Sayı: 3 Sayfa Aralığı: 140 - 144 Metin Dili: İngilizce DOI: 10.4274/tjcd.76093 İndeks Tarihi: 22-07-2019
Jejunoileal Diverticulosis has Heterogeneous Pathophysiology and Requires Special Consideration During Treatment
Öz: Jejunoileal diverticulosis (JID) is a rare condition with a reported incidence lower than 0.1%. The clinical presentation of JID varies widely; theincidence of complications requiring surgical intervention is reported as 10%. Surgery is the definitive treatment for JID and can be considered toimprove the patient’s quality of life and to prevent further severe symptoms. The first patient was a 77-year-old male with a history of JID that hadcaused intermittent abdominal pain for the last year. He underwent laparoscopic surgery without segmental resection, however, symptoms recurredand he underwent definitive robotic small bowel resection. Pathology revealed JID with true diverticula. The second patient was a 72-year-old malewho presented with rectal bleeding that caused hypotension. Jejunostomy was required initially and definitive open surgery was performed later toresect the bowel segment affected by JID. Pathology showed pseudodiverticular JID. JID patients may present with a pseudodiverticulum or a truediverticulum, with severe or mild symptoms and with perforation or minimal inflammation. Physicians treating this heterogeneous disease need toknow the complex underlying mechanisms as well as the multiple management options. We share our experience with two distinct cases and discussthe presentation and management approaches for JID to give an inclusive picture of the disease.
Anahtar Kelime: Konular:
Jejunoileal Divertiküllerin Patofizyolojisi Değişkendir ve Müdahalesi Özel Dikkat Gerektirir
Öz: Jejunoileal divertikülozis (JID) az görülen bir durumdur ve bildirilmiş insidansı %0,1’in altındadır. Hastaların klinik tablosu değişken olmakla birlikte, cerrahi müdahale gerektiren komplikasyonların sıklığı %10 olarak bildirilmiştir. JID kesin tedavisi cerrahidir; hastaların hayat kalitesini artırmak ve ileride daha ağır semptomlar ile başvurmalarını önlemek için düşünülmelidir. İlk olgu bilinen JID geçmişi olup, son 1 yılda aralıklı karın ağrısı şikayetleri oluşturan 77 yaşında bir erkek hastadır. Segmental rezeksiyon yapılmadan laparoskopik yolla ameliyat edilmiş olmasına rağmen semptomları tekrarlamış ve robotik ince barsak rezeksiyonu uygulanmıştır. Patoloji sonuçlarına göre gerçek divertikülleri olan JID bildirilmiştir. İkinci olgu hipotansiyone yol açan rektal kanama ile başvuran 72 yaşında bir erkek hastadır. Başlangıçtaki müdahelesinde jejunostomi açılmıştır ve daha sonra JID ile etkilenen bağırsak segmentini çıkarmak için açık cerrahi uygulanmıştır. Bu hastanın patoloji sonuçları pseudo-divertikül ile uyumlu bulunmuştur. JID hastaları pseudo-divertikül ya da gerçek divertikül şeklinde, şiddetli veya hafif semptomlarla ve perforasyon ya da minimal enflamasyon ile başvurabilirler. Bu değişken hastalığı tedavi edecek olan hekimler, hastalığın gelişiminin altında yatan kompleks mekanizmaları ve tedavisi için kullanılabilecek birden çok seçeneğini bilmelidirler. Biz bu birbirinden farklı iki olgu ile, hastalığın kliniğe geliş tabloları ve tedavi yaklaşımları ile ilgili tecrübelerimizi paylaşıyoruz.
Anahtar Kelime: Konular:
Belge Türü: Makale Makale Türü: Olgu Sunumu Erişim Türü: Erişime Açık
- Altemeier WA, Bryant LR, Wulsin JH. The surgical significance of jejunal diverticulosis. Arch Surg 1963;86:732-745.
- Wilcox RD, Shatney CH. Surgical implications of jejunal diverticula. South Med J 1988;81:1386-1391.
- Akhrass R, Yaffe MB, Fischer C, Ponsky J, Shuck JM. Small-bowel diverticulosis: perceptions and reality. J Am Coll Surg 1997;184:383-388.
- Longo WE, Vernava AM 3rd. Clinical implications of jejunoileal diverticular disease. Dis Colon Rectum 1992;35:381-388.
- Krishnamurthy S, Kelly MM, Rohrman CA, Schuffler MD. Jejunal diverticulosis: a heterogeneous disorder caused by a variety of abnormalities of smooth muscle or myenteric plexus. Gastroenterology 1983;85:538- 547.
- Makris K, Tsiotos GG, Stafyla V, Sakorafas GH. Small intestinal nonmeckelian diverticulosis. J Clin Gastroenterol 2009;43:201-207.
- de Bree E, Grammatikakis J, Christodoulakis M, Tsiftsis D. The clinical significance of acquired jejunoileal diverticula. Am J Gastroenterol 1998;93:2523-2528.
- Ferreira-Aparicio F, Gutiérrez-Vega R, Gálvez-Molina Y, Ontiveros-Nevares P, Athie-Gútierrez C, Montalvo-Javé EE. Diverticular disease of the small bowel. Case Rep Gastroenterol 2012;6:668-676.
- Liu CY, Chang WH, Lin SC, Chu CH, Wang TE, Shih SC. Analysis of clinical manifestations of symptomatic acquired jejunoileal diverticular disease. World J Gastroenterol 2005;11:5557-5560.
- Palder SB, Frey CB. Jejunal diverticulosis. Arch Surg 1988;123:889-894.
- Levack MM, Madariaga ML, Kaafarani HM. Non-operative successful management of a perforated small bowel diverticulum. World J Gastroenterol 2014;20:18477-18479.
- Kassir R, Boueil-Bourlier A, Baccot S, Abboud K, Dubois J, Petcu CA, Boutet C, Chevalier U, Montveneur M, Cano MI, Ferreira R, Debs T, Tiffet O. Jejuno-ileal diverticulitis: Etiopathogenicity, diagnosis and management. Int J Surg Case Rep 2015;10:151-153.
- Woods K, Williams E, Melvin W, Sharp K. Acquired jejunoileal diverticulosis and its complications: a review of the literature. Am Surg 2008;74:849-854.
- Chendrasekhar A, Timberlake GA. Perforated jejunal diverticula: an analysis of reported cases. Am Surg 1995;61:984-988.
- Spasojevic M, Naesgaard JM, Ignjatovic D. Perforated midgut diverticulitis: Revisited. World J Gastroenterol 2012;18:4714-4720.
| APA | BENGÜR F, Yozgatli T, bilgin i, ERENLER BAYRAKTAR İ, Aytac E (2018). Jejunoileal Diverticulosis has Heterogeneous Pathophysiology and Requires Special Consideration During Treatment. , 140 - 144. 10.4274/tjcd.76093 |
| Chicago | BENGÜR Fuat Barış,Yozgatli Tahir Koray,bilgin ismail ahmet,ERENLER BAYRAKTAR İlknur,Aytac Erman Jejunoileal Diverticulosis has Heterogeneous Pathophysiology and Requires Special Consideration During Treatment. (2018): 140 - 144. 10.4274/tjcd.76093 |
| MLA | BENGÜR Fuat Barış,Yozgatli Tahir Koray,bilgin ismail ahmet,ERENLER BAYRAKTAR İlknur,Aytac Erman Jejunoileal Diverticulosis has Heterogeneous Pathophysiology and Requires Special Consideration During Treatment. , 2018, ss.140 - 144. 10.4274/tjcd.76093 |
| AMA | BENGÜR F,Yozgatli T,bilgin i,ERENLER BAYRAKTAR İ,Aytac E Jejunoileal Diverticulosis has Heterogeneous Pathophysiology and Requires Special Consideration During Treatment. . 2018; 140 - 144. 10.4274/tjcd.76093 |
| Vancouver | BENGÜR F,Yozgatli T,bilgin i,ERENLER BAYRAKTAR İ,Aytac E Jejunoileal Diverticulosis has Heterogeneous Pathophysiology and Requires Special Consideration During Treatment. . 2018; 140 - 144. 10.4274/tjcd.76093 |
| IEEE | BENGÜR F,Yozgatli T,bilgin i,ERENLER BAYRAKTAR İ,Aytac E "Jejunoileal Diverticulosis has Heterogeneous Pathophysiology and Requires Special Consideration During Treatment." , ss.140 - 144, 2018. 10.4274/tjcd.76093 |
| ISNAD | BENGÜR, Fuat Barış vd. "Jejunoileal Diverticulosis has Heterogeneous Pathophysiology and Requires Special Consideration During Treatment". (2018), 140-144. https://doi.org/10.4274/tjcd.76093 |
| APA | BENGÜR F, Yozgatli T, bilgin i, ERENLER BAYRAKTAR İ, Aytac E (2018). Jejunoileal Diverticulosis has Heterogeneous Pathophysiology and Requires Special Consideration During Treatment. Türk Kolon ve Rektum Hastalıkları Dergisi, 28(3), 140 - 144. 10.4274/tjcd.76093 |
| Chicago | BENGÜR Fuat Barış,Yozgatli Tahir Koray,bilgin ismail ahmet,ERENLER BAYRAKTAR İlknur,Aytac Erman Jejunoileal Diverticulosis has Heterogeneous Pathophysiology and Requires Special Consideration During Treatment. Türk Kolon ve Rektum Hastalıkları Dergisi 28, no.3 (2018): 140 - 144. 10.4274/tjcd.76093 |
| MLA | BENGÜR Fuat Barış,Yozgatli Tahir Koray,bilgin ismail ahmet,ERENLER BAYRAKTAR İlknur,Aytac Erman Jejunoileal Diverticulosis has Heterogeneous Pathophysiology and Requires Special Consideration During Treatment. Türk Kolon ve Rektum Hastalıkları Dergisi, vol.28, no.3, 2018, ss.140 - 144. 10.4274/tjcd.76093 |
| AMA | BENGÜR F,Yozgatli T,bilgin i,ERENLER BAYRAKTAR İ,Aytac E Jejunoileal Diverticulosis has Heterogeneous Pathophysiology and Requires Special Consideration During Treatment. Türk Kolon ve Rektum Hastalıkları Dergisi. 2018; 28(3): 140 - 144. 10.4274/tjcd.76093 |
| Vancouver | BENGÜR F,Yozgatli T,bilgin i,ERENLER BAYRAKTAR İ,Aytac E Jejunoileal Diverticulosis has Heterogeneous Pathophysiology and Requires Special Consideration During Treatment. Türk Kolon ve Rektum Hastalıkları Dergisi. 2018; 28(3): 140 - 144. 10.4274/tjcd.76093 |
| IEEE | BENGÜR F,Yozgatli T,bilgin i,ERENLER BAYRAKTAR İ,Aytac E "Jejunoileal Diverticulosis has Heterogeneous Pathophysiology and Requires Special Consideration During Treatment." Türk Kolon ve Rektum Hastalıkları Dergisi, 28, ss.140 - 144, 2018. 10.4274/tjcd.76093 |
| ISNAD | BENGÜR, Fuat Barış vd. "Jejunoileal Diverticulosis has Heterogeneous Pathophysiology and Requires Special Consideration During Treatment". Türk Kolon ve Rektum Hastalıkları Dergisi 28/3 (2018), 140-144. https://doi.org/10.4274/tjcd.76093 |
