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Multiple jejuno-jejunal fistulae of uncertain origin: a case report
© Katsoulis et al; licensee BioMed Central Ltd. 2007
Received: 07 May 2007
Accepted: 23 November 2007
Published: 23 November 2007
A 43 year-old male patient presented with small bowel obstruction while being treated for cervical tuberculous lymphadenopathy. Laparotomy revealed multiple adhesions and multiple jejuno-jejunal fistulae. Absence of previous abdominal surgery or other abdominal insult favoured an 'idiopathic' origin of these unusual lesions, although treated tuberculosis may have been the underlying cause. To the best of our knowledge this intestinal condition has never previously been reported in the medical literature.
Adhesions are by far the commonest cause of small bowel obstruction. Other causes include hernias, neoplasms, inflammatory causes, mesenteric vascular occlusion and intussusception. There are also reports of various unusual causes .
Recovery of bowel motility and absorption was slow and the patient required parenteral nutrition for a period of 10 days. He was discharged home on the 20th postoperative day. Three months after discharge the patient had no residual abdominal symptoms and was well nourished.
Clinical presentation of this patient in combination with his history of cervical tuberculous lymphadenopathy raised suspicion of abdominal TB. However, CT showed small bowel obstruction without appearances typical of TB . Furthermore, laparotomy revealed extensive adhesions and multiple jejuno-jejunal fistulae and there was no evidence of tuberculomas, ascites or other acute or chronic inflammatory changes. Adhesions were the apparent cause of intestinal obstruction. The aetiology of these was not however clear, nor that of the fistulae between the jejunal loops. Absence of previous abdominal surgery or other abdominal insult favoured an 'idiopathic' origin of these lesions, although treated TB may have been the underlying cause. We do not know if it was necessary to divide all or any of the fistulous bridges between the jejunal loops. However, in view of the rarity of the findings and lack of previous experience with such a case, it was felt that leaving these fistulae intact might result in further obstructive episodes due to internal herniation and incarceration.
Regardless of their underlying aetiology, jejuno-jejunal fistulae are a very unusual pathology which can be associated with intestinal obstruction. To the best of our knowledge there are no previous reports of this condition in the literature.
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