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Case report: Challenges in diagnosis and treatment of Small bowel diverticulitis presenting with acute abdomen

机译：病例报告：急性腹部小肠憩室炎的诊治挑战

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Small bowel diverticulitis is a rare condition that is often excluded in the differential diagnosis of acute abdomen. We herein present two cases of patients with small bowel diverticulitis who presented with acute abdomen. First case was a 72-year-old lady who presented to emergency with 2 days of sudden-onset worsening generalized abdominal pain. The computed tomography (CT) revealed a segment of abnormally thickened jejunum with marked adjacent inflammatory mesenteric fat stranding and adjacent extraluminal gas locules, in keeping with complicating perforation. The patient was subsequently taken to the operating theater for an emergency laparotomy which revealed a contained perforation of the proximal jejunum secondary to a ruptured diverticulum. 20 cm of proximal jejunum containing the perforation was resected. The patient recovered uneventfully and was discharged day 7 following the operation. Second case was a 78-year-old lady who presented with 12 h of sudden-onset right-sided abdominal pain. The CT revealed the presence of multiple diverticula in the jejunum associated with diffuse wall thickening and marked peridiverticular inflammatory changes. This was most in keeping with small bowel diverticulitis, however, there was no definite extraluminal gas to suggest any evidence of perforation. The patient was managed conservatively with intravenous antibiotics and bowel rest. The patient’s pain improved with improving inflammatory markers during the hospital stay. The patient was discharged day 4 following the admission. We believe that there is a need to devise a comprehensive treatment guidelines specific for small bowel diverticulitis. In the meantime, it is deemed safe to conservatively manage uncomplicated cases without perforation.
机译：小肠憩室炎是一种罕见的疾病，在急性腹部的鉴别诊断中通常被排除在外。我们在这里介绍了两例急性腹部小憩室炎患者。第一例是一名72岁的女士，她因突发性腹泻加重了两天而急诊。计算机断层扫描（CT）显示，空肠异常增厚，并伴有明显的炎性肠系膜脂肪链和邻近的腔外气管，并伴有复杂的穿孔。该患者随后被送往手术室进行紧急剖腹手术，结果发现继发于憩室破裂的近端空肠出现穿孔。切除包含穿孔的近端空肠20 cm。病人康复良好，术后第7天出院。第二例是一名78岁的女士，她出现了12小时的突然发作的右侧腹部疼痛。 CT显示空肠中存在多个憩室，伴有弥漫性壁增厚和明显的憩室周围炎性变化。这最符合小肠憩室炎，但是，没有明确的腔外气体提示有穿孔的迹象。保守治疗静脉注射抗生素和肠道休息。通过改善住院期间的炎症标记，患者的疼痛得到改善。患者入院后第4天出院。我们认为有必要针对小肠憩室炎制定全面的治疗指南。同时，保守地处理没有穿孔的简单病例被认为是安全的。

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