Perforated jejunal diverticulum: a rare case of acute abdomen

Abstract

Jejunal pseudo-diverticulosis is a rare acquired herniation of the mucosa and submucosa through weakened areas of the muscularis mucosa of the mesenteric aspect of the bowel. They are asymptomatic in the majority of cases; however, they can present with a wide spectrum of non-specific symptoms such as chronic abdominal discomfort, postprandial flatulence, diarrhoea, malabsorption and steattorhoea. In up to 15% of cases, more serious acute complications may arise such as the development of intestinal obstruction, haemorrhage or as in our case, localized peritonitis secondary to perforation. Perforation carries an overall mortality rate of up to 40% and exploratory laparotomy followed by copious lavage with segmental resection and primary anastomosis remains the mainstay of managing such sequalae of jejunal pseudo-diverticulosis. Our case report highlights the importance of maintaining a high clinical suspicion of a perforated jejunal diverticulum in an elderly patient presenting with an acute abdomen.

Figure 1:

CT of abdomen with contrast revealing small pockets of intra-abdominal free air noted throughout the whole abdomen with mild fat stranding at the level of the mesenterium at the left paramedial lower abdomen and small amount of intrapelvic free fluid. A background of significant diverticular disease involving a redundant sigmoid which courses cranially to the umbilical region as well as scattered throughout the entire colon. This is suspicious for perforation within a hollow viscus (red arrow).

Figure 2:

Multiple large ileo-jejunal diverticulae were found throughout the small bowel (blue arrow) and sigmoid colon. There was a perforation noted of a single large distal jejunal diverticulum (orange arrow).

Figure 3:

Histological examination showing H&E stained jejunal diverticulum.