An 81-year-old man referred to Hazrat Rasul Akram hospital with abdominal discomfort, nausea and vomiting from two days ago. He was admitted and treated with bowel rest and serum supplementation, but he did not respond to conservative therapy. In his past medical history, he had been treated medically (conservative management) for small bowel obstruction 2 years ago.
His past surgical history was open appendectomy and laparoscopic inguinal hernia repair with transabdominal pre-peritoneal method (TAPP).
On physical examination, he had soft abdomen, no tenderness or rebound and a mobile palpable mass was detected in right upper quadrant (RUQ) of abdomen. His blood pressure was 130/90 mmHg, pulse rate was 90/min, respiratory rate was 18/min, and oral temperature was 37.2°C.
His laboratory blood tests were within normal range: white blood cell = 6700 µg/dL, with 64% polymorphonuclear, hemoglobin = 12.4 g/dL, prothrombin time = 13 sec, partial thrombin time = 35 sec, sodium = 137 mEq/L, potassium = 4.2 mEq/L, blood urine nitogen = 21 mg/dL, creatinin = 0.8 mg/dL, calcium = 9.5 mEq/L. Abdominal X ray showed two air fluid levels. Ultrasound revealed full fluid bowel loop and no free fluid in abdominal cavity. Computer tomography (CT) scan showed a well regular solid mass of 10 × 13 centimeters located in the RUQ of abdomen, which was suspected (due to radiologist report) to originate from small bowel without connection to bladder.
During diagnostic laparoscopy, significant amount of adhesion was seen in the right side of abdomen; in addition to a large mass in terminal ileum about 20 cm to ileocecal valve (
Figure 1. Ileal Mass
Figure 2. Resection of Ileum
Laparoscopic adhesiolysis was done and after full recognition of anatomy, it seemed to be small bowel diverticula, but completely solid. Then, small bowel resection was done with 5cm margin from each side with linear 60 mm blue echelon staples in small bowel site. Side-to-side anastomosis was done with one 60mm blue stapler and the stab was closed with PDS 2/0.
In postoperation period, the patient had no problem and had bowel movement after 3 days and was discharged from hospital on day 4. The patient was completely free from constipation in first and third and sixth month after surgery.
Pathology findings revealed multiple diverticulums with some degrees of inflammation in lamina properia.
We obtained informed consent from the patient who enrolled in our study.