Perforation of diverticulum of jejunum by foreign body (clinical case)

Abstract

Aim: to highlight the clinical course, diagnosis and treatment of perforation of a diverticulum of the jejunum by a foreign body of vegetable origin (a bay leaf). Materials and Methods. Retrospective analysis of the clinical case of a patient who was hospitalized in the 2nd surgery department of the Lviv Regional Hospital (LRH). Results and Discussion. Patient B., 88 years old, on 04.12.13 was admitted into surgery department with complaints of the right upper quadrant pain, nausea, and vomiting. The general condition was of moderate severity. The abdomen was painful on palpation in the right upper quadrant and epigastric area. After the examination, a diagnosis of GSD (chronic obstructive calculous cholecystitis) was established.. Medical treatment t was appointed, which led to a slight improvement. In the morning of 06.12.2013 the patient's condition deteriorated: there appeared pain around the abdomen, abdominal distension, and dryness of the tongue. Urgent diagnostic laparoscopy was performed, which showed profuse turbid effusion in the abdominal cavity with a large quantity of loose fibrinous layering. Conversion: upper middle laparotomy. At a distance of 40 cm from the ligament of Treitz multiple diverticula of the jejunum were found, one of which was perforated. A bay leaf petiole was located adjacent to the perforating hole. The foreign body was removed through a perforated hole, followed by suturing. The stitched loop of the small intestine was placed outside abdominal cavity; sanitation and drainage of abdominal cavity and small pelvis was performed. On the fourth day after the operation a failure of the suture of the loop of the jejunum occurred. The plot of failure was closed by imposing n-Butyl-cyanoacrylate glue. On the fifth day the patient's condition worsened;, there were disturbances of breathing and hemodynamics. For further treatment, the patient was transferred to the intensive care unit of LRH. Despite the continuous intensive therapy, the patient's condition deteriorated. The growing signs of multiple organ dysfunction led to a fatal outcome on 18.12.2013. Conclusions. 1. Damage of the integrity of the wall of the small intestine by a foreign body of plant origin is very rare. It is enhanced by comorbidity - the multiple diverticula of the small intestine. 2. The signs of chronic obstructive cholecystitis at admission to hospital diverted attention during elaboration of of diagnostic and therapeutic procedure.

Keywords

• foreign body, diverticulum of the jejunum, perforation, peritonitis