Abstract book 6th RMS 16.indd

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Diffuse Giant Small Bowel
Diverticulosis Presenting with
Intestinal Obstruction: A Case Report
and Literature Review
Jehad Odeh MD*, Somayya Ja’afreh MD,
Hussein Alhusban MD
* Senior Specialist in General Surgery, Queen
Alia Military Hospital, Royal Medical Services
(Jordan)
jehad19652000@yahoo.com
Objectives: Here we present a case
of diffuse giant jejunal diverticulosis
that present with intestinal Volvulous
Methods: Case report: A 61 year old
female patient who presented with severe
acute abdominal pain and vomiting of 2
days prior to admission.
Plain abdomen radiograph showed
significant dilatation of small bowel loops
with multiple air fluid levels. (Fig 1). A
provisional diagnosis of small intestinal
obstruction was made and the patient
was admitted accordingly. Conservative
management was started with an N/G
tube was inserted. Abdominal ultrasound
scan showed grossly dilated small bowel
loops with excessive bowel motion .Free
intraperitoneal fluid was seen at time
of examination laparotomy confirmed
the presence of volvulus with “dusky
“appearance and perforations at the
diverticula in the obstructed loop and
enumerable large sized diverticula
involving the whole small bowel
starting from the duodenum distal to
the ileum figure 3. The obstructed loop
was excised with a satisfactory safety
margins. End - to -end anastomosis
was made. The post operative course
Results:Diverticulosis of the small bowel
is a rare disease and may be congenital or
acquired with a prevalence of about 1% in
general population (10). The incidence of
jejunoileal diverticula in studies of the small
bowel by enteroclysis is 2-2.3% which is
comparable to autopsy data presenting an
incidence of 1.3-4.6% for diverticula of
the jejunum and ileum The case we report
represents a rare occurrence of diverticula
disease involving the whole length of
small bowel loops at the same time.
Conclusion:This is a new case diffuse
giant small bowel diverticulosis that
present with strangulation of the
jejunum due to volvulus. Although this
case is rare, small bowel diverticula
may present with different situations
Keywords: Small bowel diverticulosis;
jejunal diverticulum; intestinal
obstruction; acute abdomen, whirl sign,
Hall B Session 4
Hepatobiliary Surgery
34
Screening Patients for Hepatocellular
Cancer
Steven Curley MD (USA)
Historically, only 10% of hepatocellular
cancer (HCC) patients are diagnosed
with early stage, potentially curable
disease. We prospectively screened
chronic hepatitis virus-infected patients
to determine 1) the proportion diagnosed
with potentially curable HCC, and 2)
survival following curative therapy. The
study included 5670 chronic hepatitis B
(1,077, 19.0%), C (4,196, 74.0%), or both
(397, 7.0%)-infected patients enrolled in
a prospective screening program (Hepato
gastroenterology2009;56(93):1152-1156).
Screening was every 6 months with serum
alpha-fetoprotein (AFP) measurement
and ultrasonography. Curative treatments
included liver transplantation, resection,
RFA, and/or ethanol injection.HCC was
diagnosed in 464 (8.2%) patients. Of 1006
cirrhotic patients, 462 (45.9%) developed
HCC. Curative treatment was possible in
319 (68.7%). The 2- and 5-year overall
survival rates in the curative treatment
group were 65% and 28%, respectively,
compared to 10% and 0% in the advanced
disease group (p < 0.001).Prospective
screening of patients at high risk to develop
HCC increases the proportion diagnosed
with potentially curable disease. This may
result in an increase of the number of longterm
survivors. A screening strategy should
focus on those patients with chronic
hepatitis B or C virus infection that has
progressed to cirrhosis since more than
40% of these patients will develop HCC.
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