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Small-bowel diverticulosis.

Steven C Cunningham1, Christopher J Gannon, Lena M Napolitano

  • 1General Surgery and Critical Care, VA Maryland Health Care System, Baltimore, Baltimore, MD 21201, USA.

American Journal of Surgery
|June 24, 2005
PubMed
Summary
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Diffuse jejunoileal diverticulosis can cause pneumoperitoneum without peritonitis. If no perforation is found during surgery, irrigating the abdomen and closing it is the recommended approach for this condition.

Area of Science:

  • Gastroenterology
  • Surgical Pathology
  • Abdominal Imaging

Background:

  • Diffuse jejunoileal diverticulosis is a rare condition.
  • Pneumoperitoneum can occur without peritonitis in these cases.
  • Management strategies vary based on intraoperative findings.

Observation:

  • Pneumoperitoneum in diffuse jejunoileal diverticulosis without peritonitis is uncommon.
  • Jejunoileal diverticular perforation with evident perforation requires bowel resection and anastomosis.
  • Absence of intraoperative perforation or discrete inflammation necessitates a different approach.

Findings:

  • In cases of diffuse jejunoileal diverticulosis presenting with pneumoperitoneum but no peritonitis, surgical intervention is guided by the presence or absence of a clear perforation.

Related Experiment Videos

  • When a discrete perforation or area of inflammation is not identified intraoperatively, the recommended management is copious irrigation and abdominal closure.
  • Resection and primary anastomosis are reserved for cases with evident jejunoileal diverticular perforation.

    • Implications:

    • This approach simplifies management in ambiguous cases of jejunoileal diverticulosis.
    • It avoids unnecessary extensive bowel resection when perforation is not confirmed.
    • Highlights the importance of careful intraoperative assessment for guiding surgical decisions in rare conditions.