Acute ulcerative jejunal diverticulitis: case report of an uncommon entity

Abstract

Jejunal diverticulosis is a rare entity with variable clinical and anatomical presentations. Its reported incidence varies from 0.05% to 6%. Although there is no consensus on the management of asymptomatic jejunal diverticular disease, some complications are potentially life threatening and require early surgical treatment. We report a case of an 88-year-old man investigated for acute abdominal pain with a high biological inflammatory syndrome. Inflammation of multiple giant jejunal diverticulum was discovered at abdominal computed tomography (CT). As a result of the clinical and biological signs of early peritonitis, an emergency surgical exploration was performed. The first jejunal loop showed clear signs of jejunal diverticulitis. Primary segmental jejunum resection with end-to-end anastomosis was performed. Histopathology report confirmed an ulcerative jejunal diverticulitis with imminent perforation and acute local peritonitis. The patient made an excellent rapid postoperative recovery. Jejunal diverticulum is rare but may cause serious complications. It should be considered a possible etiology of acute abdomen, especially in elderly patients with unusual symptomatology. Abdominal CT is the diagnostic tool of choice. The best treatment is emergency surgical management.

Figure 1

Axial CT image illustrating multiple diverticula (white arrows) developed on the mesenteric border of the jejunum, surrounded by inflammatory mesenteric fat. The arrowhead shows the communication between the diverticula and jejunal lumen.

Figure 2

Multiplanar reconstructions on a sagittal view demonstrating a communication between the diverticula and jejunum (white arrow).

Figure 3

Inflamed giant jejunal diverticula on macroscopic operator view.