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Diverticula at the jejuno-ileum are rare. They correspond mostly to pseudo diverticula and usually go unnoticed. Among symptomatic patients the clinical presentation is heterogeneous. We present 3 cases of it most frequent complication: acute jejunal diverticulitis

La presencia de divertículos a nivel de yeyuno-íleon es infrecuente. Ellos corresponden mayormente a pseudo divertículos y suelen pasar desapercibidos. Entre los casos sintomáticos, la presentación clínica es heterogénea. Presentamos 3 casos de diverticulitis aguda yeyunal que es la complicación más frecuente.

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Jejunal diverticular disease is a very uncommon pathology often asymptomatic. Associated complications appear in less than 30% of patients and they can present as diverticulitis, refractary inflammation, obstruction, hemorrhage, perforation or intraabdominal abscess formation. Clinical manifestations are usually unspecific and high suspicion index is required to reach the diagnosis. Treatment of complications includes volume replacement, transfusions, antibiotic therapy, percutaneous drainage or surgical intervention. We present a retrospective observational study of the cases treated in our hospital between 2007 and 2016.

La enfermedad diverticular yeyunal es una condición clínica muy poco frecuente y habitualmente asintomática. Las complicaciones asociadas aparecen en menos del 30% de los pacientes y pueden manifestarse como inflamación de los divertículos, obstrucción intestinal, hemorragia digestiva, malabsorción intestinal, formación de abscesos intraabdominales y perforación. La clínica de los pacientes es muchas veces inespecífica, requiriendo un alto grado de sospecha para llegar al diagnóstico. El tratamiento de las complicaciones de la enfermedad diverticular es variado, incluyendo reposición de volumen o transfusiones, antibioticoterapia, drenaje percutáneo o intervención quirúrgica. Presentamos un estudio observacional retrospectivo de los casos tratados en nuestro hospital entre 2007 y 2016.

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BACKGROUND: Roux-en-Y gastric bypass (RYGBP) is currently one of the most frequently performed procedures for the surgical treatment of morbid obesity. The success of this procedure's restrictive component requires a small gastrojejunostomy (GJ), which occasionally results in stenosis. The treatment of choice for this complication is balloon dilation. This study aimed to evaluate the feasibility and safety of ambulatory management for stenosis of the GJ using endoscopically guided Savary-Gilliard dilators. METHODS: Between January 1998 and October 2003, 769 patients underwent RYGBP. The mean age of these patients was 38 +/- 12 years, and their mean body mass index (BMI) was 43 +/- 6 kg/m2. Of these 769 patients, 520 (68%) underwent open surgery and 249 (32%) underwent laparoscopic RYGBP. Patients suspected of GJ stenosis were referred for upper gastrointestinal endoscopy. Those who presented with stenosis were managed endoscopically with Savary-Gilliard dilators. RESULTS: Stenosis at the GJ was confirmed in 53 patients (6.9%). A total of 71 dilations were performed for these patients, resulting in a mean of 1.3 dilations per patient. One dilation was needed for 41 patients (75.5%), two dilations for 9 patients (16.9%), three dilations for 3 patients (5.7%), and four dilations 1 patient (1.9%). The patients subjected to open RYGBP required a mean of 1.57 dilations, and those who had laparoscopic RYGBP required mean of 1.08 dilations. The mean time for the first dilation was 51 +/- 28 days after surgery (range, 20-178 days). All the dilations were performed in ambulatory settings. One patient (1.9%) was admitted after GJ dilation for pain. He was discharged without symptoms after 2 days with no need for invasive procedures. CONCLUSIONS: The management and treatment of GJ stenosis after RYGBP can be effectively accomplished in ambulatory settings using endoscopically guided Savary-Gilliard dilators, with good and safe results.

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Involvement of the hollow organs of the digestive apparatus can occur in patients in the chronic phase of Chagas' disease. The basic mechanism is destruction of neurons of the enteric nervous system. Whereas megaesophagus and megacolon are the most notable and most extensively studied expressions of the digestive form of Chagas' disease, involvement of the small intestine (Chagasic enteropathy) is less frequent and less known than involvement of the two above mentioned entities. Chagasic enteropathy can be responsible for important clinical and laboratory manifestations resembling those of dyspeptic syndrome, intestinal pseudo-obstruction and bacterial overgrowth in the small intestine. Chagasic enteropathy also involves peculiar functional changes, especially those related to motor activity of the organ and to intestinal absorption of carbohydrates. In practice, the diagnosis is based on radiographic documentation of dilation of visceral segments. Treatment consists of clinical control of the above syndromes and, eventually, appropriate surgical operations.

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INTRODUCTION: Diverticular disease of small bowel is an uncommon entity and may be the cause of vague abdominal symptoms generally an incidental finding that occasionally require surgical therapy for resolution. METHOD: We report a case of a patient with complicated solitary jejunal diverticulum with perforation and non-Meckelean heterotopic gastric tissue that required resection, and include a review of the literature of this association. CONCLUSION: Surgical treatment of diverticular disease of the small bowel is limited to symptomatic patients with non-response to medical therapy or who have some acute complications of same.

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This is a preliminary report on an eight-year-old child with uremia (terminal renal failure) on chronic dialysis, that developed a postoperative high output small bowel fistula associated with sepsis and malnutrition. She was successfully treated with a Total Parenteral Nutrition (TPN) scheme including an amino acid solution with 60% essential amino acids and 40% non-essential amino acids, now available in Peru, without increasing the frequency of hemodialysis for a 72-day period on TPN. Attention is drawn to Nutritional Support Team Approach.

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A doença diverticular jejunoileal (DDJI) adquirida é uma entidade rara. É constituída de divertículosd de pulsäo, formados a partir da discenesia intestinal, essejando dilemas no diagnóstico e na terapêutica dos mais dif;iceis. É encontrada principalmente entre os 60 e 80 anos de idade e o sexo masculino, sendo os divertículos geralmente múltiplos e mais numerosos no jejuno e mais solitários no íleo terminal. O diagnóstico pré-operatório é muito difícil e somente conseguido através de RX (trânsito digestivo), angiografia seletiva da mesentérica superiorr e exames com marcadores nucleares. Deve-se pensar em DDJI em pacientes com quadros inexplicáveis de: hemorragia digestiva, obstruçäo e perfuraçäo intestinais, malabsorçäo, anemia, diarréia e dor abdominal crônica. O tratamento médico é útil para controlar anemia, diarréia e dor, enquanto a cirurgia é indispensável para debelar a obstruçäo, a perfuraçäo e a hemorragia. Durante a cirurgia abdominal os divertículos jejunoileais incidentais devem ser removidos quando há evidências de alteraçöes dos mesmos ou de dilataçäo ou hipertrofia de alças intestinais. Os divertículos jejunoileais encrontrados incidentalmente em estudos radiológicos de trânsito intestinal näo devem receber intervençäo cirúrgica. Fazemos, neste trabalho, uma revisäo retrospectiva de 10 pacientes portadores de DDJI, notando, inicialmente, sua predileçäo para o sexo masulino (7 casos), entre 42 e 84 anos de idade, com média de 61,6 anos. O número individual de divertiículos variou de 1 a 13, com média de 4,8, sendo mais comuns no jejuno (7 casos). A DDJI pode ser e foi encontrada sob 4 formas distintas em termos propedêuticos: a) encontro radiológico incidental durante a propedêutica de 1 paciente com alguma doenç intestinal já diagnosticada; b) em 1 paciente, a DDJI ddiagnosticada angiológica e radiologicamentee (trânsito digestivo), tendo sido a causa única de hemorragia intestinal de grande porte; c) em 2 pacientes a DDJI contitui achado insuspeito como causa de obstruçäo intestinal mecânica (1 caso) e hemorragia intestinal grave (1 caso) no pré-operatório de laparotomia; d) em 6 pacientes, a DDJI constituiu um achado incidental durante laparotomia visanddo à abordagem cirúrgica de afecçöes colorretais. O tratamento cirúrgico foi realizado em 7 casos de DDJI: 2 casos de hemorragia digestiva grave, 1 caso de obstruçäo mecânica de intestino delgado e 4 casos de achados incidentais durante laparotomias para coloectomia, em que julgamos haver indicaçäo cirúrgica

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