Perforated Jejunal Diverticula: A Case Report
Perforated Jejunal Diverticula: A Case Report
Introduction: Jejunal diverticula are rare and are usually asymptomatic. However, they may cause chronic non-specific symptoms or rarely lead to an acute presentation.
Case presentation: We report the case of an 82-year-old Caucasian woman presenting with a one-day history of generalized abdominal pain, with three episodes of vomiting. An abdominal X-ray displayed multiple dilated loops of the small bowel. A subsequent computed tomography scan of the abdomen and pelvis revealed a thickening of the duodenum and dilatation of the proximal jejunum. Multiple small bowel diverticula were identified with surrounding pockets of free air adjacent to the jejunal diverticula suggestive of a small bowel perforation. Our patient underwent a laparotomy, which identified multiple jejunal diverticula with two pinhole jejunal perforations and associated fecal contamination. The perforations were repaired with primary closure and extensive washout was performed.
Conclusion: Jejunal diverticulosis in the elderly can lead to significant morbidity and mortality and so should be suspected in those presenting with crampy abdominal pain and altered bowel habits.
Jejunal diverticula are rare with an incidence of less than 0.5%. Pathologically, they are pseudodiverticula of the pulsion type, resulting from increased intra-luminal pressure and weakening of the bowel wall. These outpouchings only contain mucosa and submucosa.
Despite most cases of jejunal diverticulosis remaining completely asymptomatic, complications are reported in 10 to 30% of patients. These include chronic abdominal pain, malabsorption, hemorrhage, diverticulitis, obstruction, abscess formation and rarely diverticular perforation.
We present a rare cause of acute abdominal pain with a case of perforated jejunal diverticula. We also review the literature associated with the management of small bowel diverticular disease.
Abstract and Introduction
Abstract
Introduction: Jejunal diverticula are rare and are usually asymptomatic. However, they may cause chronic non-specific symptoms or rarely lead to an acute presentation.
Case presentation: We report the case of an 82-year-old Caucasian woman presenting with a one-day history of generalized abdominal pain, with three episodes of vomiting. An abdominal X-ray displayed multiple dilated loops of the small bowel. A subsequent computed tomography scan of the abdomen and pelvis revealed a thickening of the duodenum and dilatation of the proximal jejunum. Multiple small bowel diverticula were identified with surrounding pockets of free air adjacent to the jejunal diverticula suggestive of a small bowel perforation. Our patient underwent a laparotomy, which identified multiple jejunal diverticula with two pinhole jejunal perforations and associated fecal contamination. The perforations were repaired with primary closure and extensive washout was performed.
Conclusion: Jejunal diverticulosis in the elderly can lead to significant morbidity and mortality and so should be suspected in those presenting with crampy abdominal pain and altered bowel habits.
Introduction
Jejunal diverticula are rare with an incidence of less than 0.5%. Pathologically, they are pseudodiverticula of the pulsion type, resulting from increased intra-luminal pressure and weakening of the bowel wall. These outpouchings only contain mucosa and submucosa.
Despite most cases of jejunal diverticulosis remaining completely asymptomatic, complications are reported in 10 to 30% of patients. These include chronic abdominal pain, malabsorption, hemorrhage, diverticulitis, obstruction, abscess formation and rarely diverticular perforation.
We present a rare cause of acute abdominal pain with a case of perforated jejunal diverticula. We also review the literature associated with the management of small bowel diverticular disease.
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