Jejunal Diverticulosis: A Spectrum of Presentations

Abstract

Purpose: Jejunal diverticulosis is a rare disease with clinical presentations that vary widely. It has a prevalence of approximately 1% in the general population. In autopsy studies, the incidence has been reported 0.2% to 1.3%. The prevalence increases with age, peaking at the sixth and seventh decades and has found to be higher in men (58%) than in women (42%). It can be found incidentally in an asymptomatic patient or diagnosed in 10-30% of patients due to acute complications such as generalized peritonitis, acute intestinal obstruction and gastrointestinal hemorrhage. A retrospective analysis of three cases with different presentations was performed. The first case was diagnosed incidentally in a patient with a duodenal neuroendocrine tumor. A 65-year-old male presented with symptoms of abdominal bloating and gurgling and upon upper endoscopy, was found to have two duodenal polyps. Biopsy of the duodenal polyp showed focal mucosal G cell tumor. He was subsequently found to have proximal jejunal diverticulae intraoperatively. The second patient was a 53-year-old female who presented with abdominal pain and chills. She was found to have jejunal diverticulitis on CT abdomen. The third patient, who was a 28-year-old male, presented with an acute abdomen and was found to have jejunal diverticulitis with bowel perforation. He underwent a laparotomy with partial small bowel resection. Given the variable presentations and acuity of each case, the management also differed. Awareness of the spectrum of presentations of jejunal diverticulosis can prevent morbidity by facilitating early diagnosis and appropriate treatment.