Patient with jejunal ileus and rare pathology

Abstract text (incl. references and figure legends)
Case history

A difficult situation of a male patient, 58 years – old, who presented to the Surgical ED, for evaluation of 12 – hour history of sudden severe epigastric pain accompanied by blood stools, vomiting and fever. His medical history included Hashimoto's disease and plastic reconstruction of an umbilical hernia years ago.

Clinical Findings

At presentation, his vital signs were normal. On examination he appeared uncomfortable and he had tenderness with guarding and rebound tenderness mainly in upper abdomen.

Investigation/Results

Blood tests showed anemia, thrombocytopenia and high levels of CRP. In addition, impaired renal and hepatic function with electrolyte disturbances and extremely high levels of CPK. The abdominal radiograph showed hydro – air level. An abdominal CT scan with iv contrast medium followed and the findings were dilatation of jejunum as ileum.

Diagnosis

Βy combining the clinical laboratory findings with the imaging findings obtained the diagnosis of ileum.

Therapy and Progressions

The patient was admitted to the Hospital for further evaluation. Despite the conservative initial treatment, he experienced clinical deterioration and he was driven for exploratory laparotomy under general anesthesia. The findings were jejunal ileum with dilatation and ischemia. Furthermore, it was found block of lymph nodes in mesentery. Α segmental enterectomy of approximately 1 meter was performed, including the jejunum and the mesenteric lymph nodes. It was carried out 4th degree anastomosis of duodenum to ileum. The patient had normal postoperative care. Histology confirmed jejunal ischemia with reactive-type mesenteric lymph node lesions.

Comments

The jejunal ileus is a condition with difficulties both in diagnosis and in treatment. It will be presented with severe symptoms and requires immediate surgical treatment in the most of cases.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6587593/

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