SMALL BOWEL DIVERTICULAR DISEASE;

HOW OFTEN WE COME ACROSS IN EXPLORATORY LAPAROTOMY

Abstract

Objectives: 1). To see the prevalence of small bowel diverticulosis in patients presenting with acute abdomen. 2). To know
presentation and complications of diverticulosis in teaching hospital in Sialkot region of Pakistan. Introduction: Small bowel diverticular
disease may be complicated by small bowel obstruction. Multiple diverticulosis represents an uncommon pathology of the small bowel.
Related complications such as diverticulitis, perforation, bleeding or intestinal obstruction, and acute pancreatitis appear in 10-30% of
the patients, increasing the morbidity and mortality rates. This pathology which is uncommon is much higher in our study in patients
undergoing exploratory laparotomy in district level hospitals in Sialkot region of Pakistan. Study Design: Prospective and observational.
Setting and duration: Combined Military Hospital, Sialkot (June 2005 to August 2010). Islam teaching hospital, Sialkot (September 2010
to September 2012). Methods: 260 consecutive patients undergoing exploratory laparotomy for obstruction, peritonitis, pain and mass
abdomen were included in the study. Patient with established cause of obstruction were excluded. The data including demographic
information, presentation, operative findings, complications and follow up were entered in structured proforma. Patients with less than
three months of followup were also excluded from study. Results: Small bowel diverticuli were encountered in 24 (9%) out of 260 patients
including; 8 (3%) Meckel's, 9 (3.5%) jejunal, 3 (1.2%) duodenal and 4 (1.5%) Ileal diverticuli. These patients with diverticuli presented as
intestinal obstruction, peritonitis, mass abdomen, vague abdominal pain and one patient with fresh bleeding per rectum. The indications
of surgery were peritonitis 6 (25%), intestinal obstruction 13 (54.2%), abdominal mass 3(12.5%), nonspecific abdominal pain 1 (4.2%)
and fresh bleeding per rectum of obscure origin 1 (4.2%). Complications encountered as Intestinal obstruction due to adhesion formation
in 8; obstruction due to congenital bands attached to diverticuli in 3; diverticular perforation in 2; peritonitis due to diverticulitis in
2,bleeding from arteriovenous malformation within the jejuna diverticuli in 1 and mass formation due to volvulus in 1. Three duodenal
diverticuli and 4 jejunal diverticuli were found as silent pathologies synchronous with other active pathologies.