Jejunal diverticulosis as the obscure cause of acute abdominal pain

Abstract

Fig 1. Multiple diverticula mainly of the proximal jejunum. A 74-YEAR-OLD MAN was admitted with a 6-hour history of severe diffuse abdominal pain of acute onset, accompanied by nausea and flatulence. On examination, he was agitated with signs of diffuse peritonitis. The laboratory analysis revealed leukocytosis (19,100 leukocytes/mm) and mild hemodynamic instability (blood pressure, 87/64 mmHg; heart rate, 109 bpm). After initial fluid recovery, the patient underwent emergency laparotomy. The patient had no previous surgical history. The exploratory laparotomy revealed the presence of multiple diverticula mainly of the proximal jejunum (Fig 1), one of which was ruptured and caused the peritonitis (Fig 2). The patient was treated with segmental resection of the jejunum carrying the ruptured diverticulum. The intestinal segment containing the perforated diverticulum was removed and an end-to-end anastomosis was done to reconstruct the intestinal transit. Histopathology report confirmed an ulcerative jejunal diverticulitis with imminent perforation and acute local peritonitis. The patient recovered well and was discharged from hospital on postoperative day 9. There were no signs of abdominal pain 6 months after the operative procedure.