Small Intestinal Diverticulosis: A Rare Cause of Intestinal Perforation Revisited

Abstract

Jejunoileal diverticulosis (JID) is a rare and nonspecific symptomatic disease. It is usually an acquired condition associated with false diverticula and integrated with colonic diverticulosis which can be diagnosed incidentally or later with complications. A sixty-nine-year-old male presented with sudden onset generalized abdominal pain. Computed tomography (CT) imaging was suggestive of ileal diverticulitis with localized perforation. The patient was treated conservatively with IV fluids and antibiotics and kept nil per orem for three days and discharged after symptoms subsided. The patient returned with a similar presentation but with a greater intensity. CT with oral contrast revealed evidence of distal ileal perforation. The terminal ileum was resected, and a double barrel ileostomy was created. Six months later, the stoma was reversed after resecting 50 cm of proximal terminal ileum which included all diverticula. The patient had a smooth postoperative recovery. Small bowel diverticulitis is generally managed conservatively unless the patient’s clinical condition mandates urgent exploration. This report may add knowledge and lead to a change in clinical practice.

Acute Abdomen Secondary to Ileal Diverticulum: A Case Report

“…Most patients are asymptomatic; the clinical presentation is nonspecific. It can be intermittent chronic abdominal pain, constipation, diarrhea, dyspepsia, intestinal occlusion, or an acute abdomen with evidence of peritonitis [6,7]. The complication rate is 10% to 20%, with hemorrhage (2% to 8%), intestinal perforation (2% to 7%), and intestinal occlusion (2% to 4.6%) [4].…”

Perforated jejunal diverticulum as an unsual cause of acute abdomen: A case report

“…Up to 60% of patients with jejunal diverticula may have concomitant colonic diverticula [9] . It is a disease of elderly people and is slightly more common in men (a male to female ratio of 2:1) [2] , [8] , [10] . Over 80% of affected individuals are in the 7th decade of life [11] .…”

“…Most patients with jejunal diverticula are asymptomatic and in the majority of cases, jejunal diverticulosis is diagnosed incidentally either on imaging or intraoperatively [1] . Usually, this disorder is clinically silent until complicated [1] , [10] , [13] . Diverticulitis, which is the most common complication, may be asymptomatic or mimic the symptoms of irritable bowel syndrome: paroxysmal abdominal pain with cramping, dyspepsia, diarrhea, and occasional vomiting [8] , [14] .…”

“…Diagnosis is challenging since there are no pathognomic signs or symptoms. Besides, elderly individuals may present a challenge in diagnosis due to the lack of clear physical signs, which explains the need for further examinations [10] . A plain abdominal radiography is the initial imaging modality of choice, since it can show signs of perforation such as the presence of free air, or signs of intestinal obstruction such as the presence of dilated intestinal loops and air-fluid levels [15] .…”

“…In case of panjejunoileal diverticulosis, resection may have to be limited to include only the segment containing the perforated diverticulum in order to avoid short bowel syndrome [2] , [4] , [14] . In all cases, we should keep in mind that perforated jejunal diverticula is associated to a high risk of mortality, ranging from 21 to 40%, which is closely related to the delay in diagnosis as well as the inherent risks associated with the old age of patients presenting with this disease [10] .…”