Perforated jejunal diverticula: a case report

Abstract

Introduction: Jejunal diverticula are rare and are usually asymptomatic. However, they may cause chronic non-specific symptoms or rarely lead to an acute presentation.

Case presentation: We report the case of an 82-year-old Caucasian woman presenting with a one-day history of generalized abdominal pain, with three episodes of vomiting. An abdominal X-ray displayed multiple dilated loops of the small bowel. A subsequent computed tomography scan of the abdomen and pelvis revealed a thickening of the duodenum and dilatation of the proximal jejunum. Multiple small bowel diverticula were identified with surrounding pockets of free air adjacent to the jejunal diverticula suggestive of a small bowel perforation. Our patient underwent a laparotomy, which identified multiple jejunal diverticula with two pinhole jejunal perforations and associated fecal contamination. The perforations were repaired with primary closure and extensive washout was performed.

Conclusion: Jejunal diverticulosis in the elderly can lead to significant morbidity and mortality and so should be suspected in those presenting with crampy abdominal pain and altered bowel habits.

Figure 1

Abdominal X-ray displayed multiple dilated loops of small bowel.

Figure 2

CT scan of abdomen showing thickening of the duodenum and dilatation of the proximal jejunum. Multiple small bowel diverticula were identified with surrounding pockets of free air and fluid adjacent to the jejunal diverticula suggestive of a small bowel perforation.

Figure 3

Intra-operative video images displaying dilated loops of jejunum with multiple jejunal diverticula.

Figure 4

Intra-operative images of dilated loops of jejunum with multiple jejunal diverticula.