Jejuno-ileal diverticulitis: Etiopathogenicity, diagnosis and management

Abstract

Introduction: Although diverticular disease of the duodenum and colon is frequent, the jejuno-ileal diverticulosis (JOD) is an uncommon entity. The perforation of the small bowel diverticula can be fatal due to the delay in diagnosis.

Presentation of case: We report the case of a 79-year-old man presenting with generalized abdominal pain and altered bowel habits. Physical examination revealed a severe diffuse abdominal pain. A CT scan of the abdomen and pelvis with oral contrast showed thickening of the distal jejunal loop and thickening and infiltration of the mesenteric fat and the presence of free air in the mesentery suggesting a possible perforation adjacent to the diverticula. A midline laparotomy was performed. The jejunal diverticula were found along the mesenteric border. Forty centimeters of the jejunum were resected. Histopathology report confirmed the presence of multiple jejunual diverticula, and one of them was perforated. The patient tolerated the procedure and the postoperative period was uncomplicated.

Discussion: The prevalence of small intestinal diverticula ranges from 0.06% to 1.3%. The etiopathogenesis of JOD is unclear, although the current hypothesis focuses on abnormalities in the smooth muscle or myenteric plexus, on intestinal dyskinesis and on high intraluminal pressures. Diagnosis is often difficult and delayed because clinical symptoms are not specific and mainly imaging studies performs the diagnosis.

Conclusion: Because of the relative rarity of acquired jejuno-ileal diverticulosis, the perforation of small bowel diverticulitis poses technical dilemmas.

Keywords: Acute abdomen; Perforation; Small bowel diverticulum; Surgery.

Fig. 1

Abdominal CT scan revealed: multiple diverticula of the small bowel (arrow), thickening of the jejunum due to diverticulitis, and elevation of density of the jejunal mesentery that contained extraluminal air (arrowhead). Findings are suggestive of perforated jejunal diverticulitis.

Fig. 2

Small jejuno–ileal diverticulitis.

Fig. 3

Histology of the fragments (col. HES, ob. 2,5×). Jejuno–ileal diverticulosis involves only the mucosal and submucosal layers (false diverticula), and is characterized by herniation of mucosa and submucosa through the muscular layer of the bowel wall. Presence of emphysematous bulla in serous membrane.