Strangulated diverticulum: a new acute complication of small bowel diverticulosis

Abstract

Complicated jejunal diverticulosis is a difficult entity to diagnose, which can cause significant morbidity and mortality. We present the case of an 88-year-old female who presented with a unique complication of small bowel diverticulosis progressing to a strangulated diverticulum requiring emergency surgery. We present the case of an 88-year-old female who presented with abdominal pain associated with a new mass on a background of perforated diverticulitis and previous laparoscopic abdominal surgeries for division of adhesions. Due to high suspicion for the mass containing necrotic bowel, the patient was taken directly to theatre for an exploratory laparotomy and was found to have ischaemic small bowel secondary to a strangulated jejunal diverticulum. When evaluating the acute abdomen consideration should be given to the diagnosis of a strangulated jejunal diverticulum causing ischaemic small bowel, with a view to expedite to emergency surgery as the primary treatment.

Keywords: diverticulum; jejunal; strangulated.

Figure 1

Small bowel diverticulum located in the mid-jejunum. (A) Transverse view (B) Superior view. Segment of small bowel 70 mm in length with a maximum internal circumference of 60 mm. There is attached mesentery up to 40 mm thick. There is an outpouching in the serosal surface measuring 85 × 50 × 25 mm. The overlying serosa appeared thinned and was stained green and there was surrounding hemorrhage at the base of the defect within the wall.