A Case Report of Acute Localized Phlegmonous Upperjejunitis

Yasuhiro Nakamura, Sadamu Takahashi, Okitsugu Nishimura and Kouhei Shoumori*

Department of Surgery, Municipal Yashiro General Hospital
Division of Organ Pathology, Tottori University, Faculty of Medicine*

A 73-year-old woman without primary disease such as chronic hepatitis or liver cirrhosis admitted for severe abdominal pain with frequently vomiting on Nov 21, 2002, was found in physical abdominal examination to have muscle guarding and rebound tenderness. Abdominal computed tomography showed prominent thickening of the wall of the small intestine, suggesting inflammatory intestinal edema. Under suspected panperitonitis due to unknown inflammatory intestinal disease, emergency laparotomy was undertaken. A moderate amount of nonodiferous turbid yellow ascites was found throughout the abdominal cavity and a 12 cm dark-colored upperjejunum located about 50 cm on anal side from the Treitz ligament, with edema and coated purulent fibrinous exudate were confirmed. She underwent partial resection of the jejunum, abdominal irrigation, and drainage. The resected specimen showed a few mucosal erosions and edema, but no parasites, such as Anisakis, foreign bodies, fish bones, etc., were found. Culture of ascites showed no pyogenic bacteria. Histopathologically, the resected specimen was characterized by suppurative inflammation associated with marked edema and marked diffuse infiltration of neutrophilic leukocytes and gram-positive cocci in submucosa, but without eosinophilia. These findings were identical both macroscopically and microscopically to those of phlegmonous enteritis. We made a diagnosis of acute localized phlegmonous jejunitis due to suspicion of bacterial infection from small erosions of unknown origin. The patient was discharged 19 days postoperatively without complications. Although, in many reports, this disease often has a poor prognosis because of poor liver function, the abscence of primary disease may indicate good prognosis to undergo treatment adequately.

Key words
phlegmonous enteritis, upperjejunum

Reprint requests
Yasuhiro Nakamura Department of Surgery, Municipal Yashiro General Hospital
85 Iehara, Yashiro-cho, Kato-gun, Hyogo, 673-1451 JAPAN

Accepted
September 22, 2004

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