Operative Management of Perforated Jejunal Diverticulitis

Abstract

Small jejunal diverticulitis is very rare, presenting in 0.06% to 1.3% of the population. Many patients remain asymptomatic or have nonspecific symptoms such as malabsorption and abdominal pain, making diagnosis complicated. Up to 6% of patients present with acute perforation. Here, we present such a case involving a 69-year-old female who presented with altered mental status due to sepsis and generalized peritonitis from a perforated jejunal diverticulum that was successfully managed with definitive surgery. We highlight the importance of maintaining a broad differential, early resuscitation, and prompt surgical management in complicated jejunal diverticulitis. Although adjunctive studies such as computed tomography may be helpful in stable patients, definitive surgery was both diagnostic and therapeutic in this case.

Keywords: diverticulitis; jejunal; perforation; small bowel diverticulitis; small bowel resection.

Figure 1. Representative coronal and axial sections demonstrating free intraperitoneal air located largely in the upper abdomen with concomitant inflammatory fat stranding in the left upper quadrant.

Figure 2. Site of the perforated jejunal diverticulum.

Figure 3. Additional nonperforated jejunal diverticulum, as indicated by the instrument tip.