Perforation of jejunal diverticulum with ectopic pancreas

Abstract

Perforation of jejunal diverticulum is a rare complication. Here, we report a case of jejunal diverticulum penetration with surrounding ectopic pancreas. An 83-year-old female patient was admitted to our department with acute onset of severe abdominal pain lasting for half a day. Abdominal computed tomography showed outpouching of the small intestine that contained air/fluid, with multiple surrounding air bubbles in the mesentery of the small intestine. She was diagnosed with penetration of the small intestine, and an emergency laparotomy was indicated. The penetrated jejunal diverticulum was identified ~20-cm distal to the ligament of Treitz. Partial resection of the jejunum was performed, and her postoperative course was uneventful. The pathological findings confirmed diverticulum penetration into the mesentery and severe inflammation at the site, with surrounding ectopic pancreas. Furthermore, the pancreatic ducts were opened through the penetrated diverticulum. This rare case shows that the ectopic pancreas might have caused penetration of jejunal diverticulum owing to the pancreatic duct opening through the diverticulum.

Reporte de caso: diverticulitis yeyunal perforada, causa infrecuente de abdomen agudo

“…Está indicado en caso de falla o imposibilidad de un drenaje percutáneo, y en peritonitis generalizada 6 . Comprende resección intestinal del segmento afectado y anastomosis primaria término-terminal, y drenajes percutáneos radioguiados en caso de colecciones localizadas 1,2,[5][6][7][8]10,[12][13][14]17,19,26,27 . Esta resección también es obligatoria en pacientes con un divertículo de gran tamaño y asas intestinales dilatadas e hipertróficas, debido al riesgo de complicaciones 6 .…”

Acute Small Intestinal Obstruction Caused by Ectopic Pancreas. A Clinical Case Report

“…Вероятно, данную связь следует признать случайной, по крайней мере в настоящее время. При воспалении аберрантной ПЖ, локализующейся в дивертикуле Меккеля [4,5], клиническая картина может имитировать острый аппендицит [6]. 4.…”

A Case of Perforated Jejunal Diverticulum: An Unexpected Cause of Pneumoperitoneum in a Patient Presenting with an Acute Abdomen

“…The clinical presentation of perforated jejunal diverticulitis is with localized or diffuse peritonitis. The causes of perforation have been associated with an acute necrotizing inflammatory reaction, foreign body impaction, and blunt trauma to the abdominal wall [ 9 , 10 ]. Acute perforation is associated with a mortality rate of 40%, and a delay in the diagnosis or treatment can be fatal [ 8 , 9 ].…”

“…Abdominal CT is the diagnostic method of choice, but even abdominal CT has limitations for the pre-operative identification of jejunal diverticulosis as the cause of peritonitis [ 8 , 11 ]. CT can visualize abnormalities associated with jejunal diverticulosis, including outpouchings of the small intestine that contain air and/or fluid, surrounding air in the mesentery of the small intestine, dilated small bowel loops with thickened walls, abscesses, inflammatory masses, and a hyperdense appearance of the mesentery [ 10 , 11 ].…”