Jejunum with diverticula and para jejunal abscess.
GC.10457
Jejunum with diverticula and para jejunal abscess.
From a male aged 35 years who had vague abdominal discomfort for five days and then suddenly developed severe pain and vomited twice. The abdomen became rigid, the temperature rose to 101°F and the pulse rate to 100. He was diplegic due to birth injury and an alcoholic. There was no previous history of abdominal symptoms. Three hours after the onset of acute symptoms exploration revealed general peritonitis with an oedematous purulent exudate. A loop of jejunum was swollen and congested and on its mesenteric border there was an inflammatory mass, to one surface of which was attached omentum and on the other a small perforation discharging pus. About 18” of jejunum with adjacent mesentery was resected and the remaining ends of jejunum were joined by a side-to-side anastomosis. Recovery was smooth.
A portion of jejunum about 20 cm. in length with adjacent mesentery is shown, sectioned in the mesenteric plane. As seen from the outside the bowel is swollen and congested. The peritoneal coat is acutely inflamed. and is partly covered with a layer of coagulated purulent exudate. A hemispherical swelling about 5 cm. in diameter extends from the bowel into the mesentery. On one surface of this mass there is a small sinus and to the other surface there is attached a portion of omentum. On the cut surface an abscess is seen in the mesentery adjacent to the bowel. The cavity which was filled
with pus, is about 2 cm. in diameter and is surrounded by a wall of inflammatory tissue about 1 cm. thick. A diverticulum, the apex of which has perforated, leads to the centre of the abscess. Another diverticulum, 3 cm. distal, is seen protruding from the mesenteric border of the jejunum. The bowel is markedly congested and oedematous and likewise the mesentery.
