Acute Jejunal Diverticulitis: A Case Report

TL;DR

This case report describes a rare instance of acute jejunal diverticulitis in a 66-year-old man requiring surgery due to complications like perforation.

Contribution

The paper presents a rare clinical case of acute jejunal diverticulitis with surgical management and highlights its diagnostic challenges.

Findings

Acute jejunal diverticulitis can present with nonspecific symptoms and inconclusive imaging.

Surgical resection is effective for managing complicated cases with perforation.

The condition should be considered in the differential diagnosis for acute abdominal pain in older adults.

Abstract

Acquired small intestinal diverticulitis and its complications remain poorly understood due to their rarity and nonspecific presentation. Complications such as abdominal sepsis, bleeding, and perforation can lead to unfavorable outcomes. We report the case of a patient who presented with acute jejunal diverticulitis requiring surgical intervention.

A 66-year-old man with a history of endovascular abdominal aortic aneurysm repair presented with acute left lower quadrant abdominal pain and tenderness. Computed tomography (CT) detected intestinal diverticulosis, localized free air, and inflammatory changes associated with the small intestine. Exploratory laparoscopy revealed numerous proximal jejunal diverticula with perforation contained within the mesentery. A 48 cm segment of the jejunum was resected, and a primary anastomosis was performed. Surgical pathology confirmed acute small intestinal diverticulitis and serositis. The patient had an uneventful postoperative course and was discharged home on postoperative day 6.

This case highlights the diagnostic challenge in acute small intestinal diverticulitis, which may present with nonspecific signs and inconclusive radiological findings. The location of diverticula along the mesenteric border may contain perforations in the mesentery and obscure peritoneal signs. Although some patients with acute small intestinal diverticulitis may be conservatively managed, surgical intervention remains the standard of care for managing patients with complications.

Acute small intestinal diverticulitis, though exceedingly rare, can carry a significant risk of morbidity and mortality. Thus, small intestinal diverticulitis should be considered in the differential diagnosis in older adults who present with acute abdominal pain and tenderness. Surgical management remains the gold standard of treatment of severe acute small intestinal diverticulitis.

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