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.

Isolated Perforation of Multiple Jejunal Diverticulae: A Very Rare Cause of Acute Abdomen

“…Small bowel diverticulosis, however, while rarer, is a well-recognized entity that may be incidentally found or present with acute life-threatening complications. Somerling and Baille first described small bowel diverticulosis in 1794 [ 1 , 3 ]. It's unclear exactly what causes it, although some research has linked intestinal dyskinesia and aberrant neuromotor innervation to increased intraluminal pressure leading to the formation of pulsion diverticulae along the mesenteric border where the vasa recta penetrate the small intestinal wall [ 1 ].…”

“…These false diverticulae are thought to occur through weaknesses, at sites where the vasa recta enter the muscularis propria. This is a rare finding, with an estimated annual incidence of 0.06-2.3% [ 1 - 3 ]. It is rarer than colonic diverticulosis and occurs in the sixth and seventh decades with a male predominance.…”

“…Its etiology is unknown and, while often asymptomatic, 10-30% of patients develop non-specific symptoms. A small number of patients present with life-threatening complications like diverticulitis, bleeding, obstruction, and perforation [ 2 , 3 ]. Such complications must be promptly diagnosed to reduce the high risk of morbidity and mortality.…”

Bowel Perforation Due to Complicated Jejunal Diverticulitis: A Rare Case Report and Literature Review

“…Small bowel diverticulosis is a very rare event, occurring in about 1% of the population, with a greater prevalence at the duodenal level followed by the jejunal-ileal district [4]. First described by Sömmering and Baille in 1794, these are false diverticula, or pseudodiverticula, thus involving the mucosa and submucosa herniating through the muscular layer of the intestinal wall [5]. Such diverticula are acquired, generally affecting adults over 60 years of age and males [6,7].…”

Jejunal diverticulosis: A case report

“…Jejunal diverticulosis is a rare entity with an incidence of <3 % and <5 % in an autopsy and imaging, respectively [1] . Like colonic diverticulosis, it is considered an acquired pulsion type, where mucosa and submucosal layer protrude through the weakened area of a muscular layer at the points where the vessels cross the intestinal wall [2] . Although 40 % of the patients are asymptomatic, the presentations are usually non-specific, vague symptoms [3] .…”