Solitary jejunal diverticulum: a rare unexpected cause of chronic pneumoperitoneum

Abstract

Jejunal diverticula are a rare acquired herniation of the mucosa and submucosa through the muscularis propria. They are asymptomatic in the majority of cases; however, they can present with non-specific abdominal symptoms and rarely complicate leading to acute abdomen. Perforation usually results in symptoms and signs of acute peritonitis and it is not an identifiable aetiology of chronic pneumoperitoneum. Computed tomography scanning may identify intestinal wall oedema, air bubbles travelling through the mesentery, free intra-abdominal air and/or fluid. Radiological diagnosis requires a high index of suspicion of such pathology. We report a case of an isolated jejunal diverticulum as a cause for aseptic chronic pneumoperitoneum.

Keywords: Intestinal perforations; Jejunal disease; Pneumoperitoneum; Unexpected.

Figure 1

Coronal and axial computed tomography (CT) images of the abdomen: (a) pneumoperitoneum (green arrows); (b) mild pelvic collection (red arrows)

Figure 2

Axial computed tomography (CT) sections of the abdomen (CT colonogram) showing: (a) moderate amounts of perisplenic and pelvic free fluid collections (yellow arrows); (b) jejunal bowel loop with intramural linear and cystic air loculi/collections (yellow arrow). No underlying colonic pathology was detected.

Figure 3

Intraoperative image taken during laparoscopic exploration of the abdominal cavity showing air bubbles between the mesenteric leaflets at the site of the perforated diverticulum (black arrow) and the diverticulum at the mesenteric border of the jejunal loop (white arrow)