Volvulus complicating jejunal diverticulosis: A case report

Introduction: Diverticular disease is uncommon among Africans though increasing number of cases is now being reported, mainly of colonic diverticulosis. This condition afflicts all parts of the gastrointestinal tract but commonly the colon. Jejunal diverticula are rare, usually asymptomatic but may lead to an acute abdomen. Case presentation: A 68 year old female trader, who was referred from a peripheral center with insidious onset of severe colicky, generalized abdominal pain, repeated vomiting of recently ingested meal, no hematemesis. There was constipation and abdominal distension. The working diagnosis was dynamic intestinal obstruction of small bowel origin. She had emergency exploratory laparotomy following resuscitation. The findings were: volvulus of the jejunum and multiple jejunal diverticula. A resection of 80 cm of the jejunum with most of the diverticula involved in the torsion was done with an end-to-end anastomosis of the jejunum. Her out-patient follow-up has been uneventful. Discussion: Jejunal diverticular disease is rare in Africa. Our patient presented with small bowel obstruction due to volvulus. Other complications are discussed. Conclusion: Intestinal obstruction from diverticular disease is not always of colonic origin. It can occur in the jejunum

Ulcerated choledochocele: A case report

Background: The cystic dilatation of the biliary tract is an uncommon anomaly. Choledochocele, a cystic dilatation of the distal common bile duct, rarely presents clinically as massive gastrointestinal bleeding. Aim: This is to report a very rare disease condition and highlight minimal access options in surgical care. Case summary: A 13 year-old boy was referred with a day history of sudden onset of passage of bright red blood per rectum with a fainting episode. There was no anal protrusion, jaundice, recurrent epigastric pain nor bleeding from any other orifice. An initial endoscopic assessment of the upper digestive tract showed profuse bleeding from a sub-mucosal mass in the region of ampulla of Vater. Emergency laparotomy revealed small intestine filled with blood from duodenum to ileum. A duodenotomy showed a cystic mass with an ulcerated mucosa at the dome containing bilious fluid in the second part of the duodenum. The cyst was de-roofed and marsupialized. Post-operative recovery was complicated by features of adhesive small bowel obstruction on the 9th post op day and treated by laparoscopic adhesiolysis. He was discharged home in good clinical state. Conclusion: Choledochocele is a differential diagnosis in the endoscopic finding of a submucosal mass in the second part of the duodenum. An initial oesophagogastroduodenoscopy endoscopy is necessary in the evaluation of massive lower gastrointestinal bleeding