Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2023; 15(6): 1256-1261
Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1256
Small bowel diverticulum with enterolith causing intestinal obstruction: A case report
Li-Wen Wang, Peng Chen, Jiang Liu, Zhi-Wei Jiang, Xin-Xin Liu
Li-Wen Wang, Peng Chen, Jiang Liu, Zhi-Wei Jiang, Xin-Xin Liu, Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
Author contributions: Wang LW and Chen P wrote and edited the original draft; Liu XX and Liu J provided a lot of help in the operation; Jiang ZW directed the writing of the manuscript; all authors have read and approved the final manuscript.
Supported by the Hubei Chen Xiaoping Science and Technology Development Foundation, No. CXPJJH12000002-2020035; and Jiangsu Graduate Research and Practice Innovation Program, No. SJCX22_0742.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin-Xin Liu, MD, Doctor, Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Qinhuai District, Nanjing 210000, Jiangsu Province, China. yfy0055@njucm.edu.cn
Received: February 21, 2023
Peer-review started: February 21, 2023
First decision: March 14, 2023
Revised: April 4, 2023
Accepted: April 20, 2023
Article in press: April 20, 2023
Published online: June 27, 2023
Processing time: 106 Days and 22.4 Hours
Abstract
BACKGROUND

Small bowel diverticula are rare in clinics, and small intestinal obstruction caused by coprolites is rarer and difficult to diagnose early. The true incidence of these diverticula may be underestimated due to their clinical symptoms not differing from those of small bowel obstruction resulting from other causes. It is common in the elderly, although it can occur at any age.

CASE SUMMARY

This is a case report of a 78-year-old man with epigastric pain for 5 d. Conservative treatment does not effectively relieve pain, inflammatory indicators are elevated, and computed tomography suggests jejunal intussusception and mild ischemic changes in the intestinal wall. Laparoscopic exploration showed that the left upper abdominal loop was slightly edematous, the jejunum mass at the near Flex ligament was palpable, the size was about 7 cm × 8 cm, the local movement was slight, and the diverticulum was seen 10 cm downward, and the local small intestine was dilated and edema. Segmentectomy was performed. After the short parenteral nutrition after surgery, the fluid and enteral nutrition solution were pumped through the jejunostomy tube, and the patient was discharged after the treatment was stable, and the jejunostomy tube was removed in an outpatient clinic one month after the operation. Postoperative pathology: Jejunectomy specimen: (1) Small intestinal diverticulum with chronic inflammation, ulcer with full-thickness activity, and necrosis of the intestinal wall in some areas; (2) also see that the hard object is consistent with stone changes; and (3) the incision margin on both sides shows chronic inflammation of mucosal tissue.

CONCLUSION

Clinically, the diagnosis of small bowel diverticulum is difficult to distinguish from jejunal intussusception. Combined with the patient’s condition, rule out other possibilities after a timely disease diagnosis. According to the patient’s body tolerance adopt personalized surgical methods to achieve better recovery after surgery.

Keywords: Small bowel diverticulum; Surgery; Complications; Case report

Core Tip: Small bowel diverticulum is clinically rare because it lacks specific clinical symptoms and has many complications. This case report presents a patient with a small bowel diverticulum with fecalith-causing intestinal obstruction diagnosed and treated by the Department of General Surgery of Jiangsu Provincial Hospital of Traditional Chinese Medicine.