Perforated jejunal diverticulitis: A rare acute abdomen etiology

Abstract

Introduction: Diverticulosis of the small intestine are mostly located in the duodenum, followed by the jejunum and the ileum. They can be symptomatic  because of complications such as hemorrhage, intestinal obstruction, jejunal perforation, mesenteric abscess, and, rarely, generalized peritonitis. The management of symptomatic cases depends on the clinical presentation such as antibiotic therapy in cases of diarrhea, and surgery in the acute abdomen presentation.

Case Report: A 62-year-old male patient was admitted to the emergency department with the complaint abdominal pain. His physical examination revealed with generalise peritonitis findings such as sensitivity in all quadrants of abdomen, widespread defense, and  rebound . Temp: 37,8’C,  Pulse: 114/min, TA: 110/80 mmHg, WBC: 15,600 and CRP;313. Ultrasound revealed that diffuse air-fluid,  around the loop of the jejunal intestines. On laparotomy, two jejunal diverticula, 70 and 100 cm distal from the Treitz ligament, were present on the mesenteric  side. Inflammation, edema and mesenteric perforation area of 1cm, with abscess focus surrounded by intestinal mesoceum and omentum were observed in the diverticulum 100 cm distal from the Treitz ligament. Resection of only perforation-related segment with side-by-side anastomosis were performed.

Conclusion: Acquired jejunoileal diverticulosis is often associated with age over 60 years, male gender, colon diverticulosis and systemic connective tissue diseases. Only 10 to 30% of patients may had acute complications such as infection, bowel obstruction, volvulus, bleeding, and perforation which having high mortality level, usually caused by a delayed diagnosis and an advanced patient age. A diagnostic laparoscopy was also done in some cases. Jejunal diverticulitis is rare but complicated jejunal diverticulitis which can be life-threatening must be kept in mind as a cause of acute abdomen.