Abstract
Jejunal diverticulosis is most commonly an incidental intraoperative finding, while rarely can be a clinical diagnosis as demonstrated in our case and on published articles in the literature. Besides the rarity of the disease, a second factor that incommodes the preoperative diagnosis is the vague symptomatology. The case of a 72-year-old male patient is described, who was complaining for mild intensity abdominal pain, with no other specific symptoms. A leucocytosis of 12.500/mm<sup>3</sup> was revealed, with all other laboratory tests being within normal limits. CT scan showed bubbles of free air in abdominal cavity and the decision for surgical exploration was taken. In the operating room multiple large diverticula were found along the jejunum without obvious perforation. A resection of 105 cm of jejunum was performed. Patient’s postoperative recovery was uneventful and two years later he does not complain of any abdominal symptoms. Postoperatively an expert radiologist was asked to read and explain the preoperative CT scan. Radiologist’s diagnosis was that the patient had either multiple jejunal diverticula or trapped free air in peritoneal cavity. Consequently, the preoperative diagnosis is feasible with a prompt cooperation between surgeon and radiologist and a better interpretation of CT scan findings from the radiologist.
Highlights
Small bowel diverticula are sac like protrusions of the bowel wall consisted of mucosal, submucosal and serosa without muscularis layer [1]
The duration of patients’ medical history and the frequency of CT diagnosis of jejunal diverticulosis, from several authors, published during the last decade are depicted on table 1
The initial radiologist’s report was negative for jejunal diverticulosis for the first 26 patients but positive for the last 2, who were submitted to CT scan after the barium study and the radiologist could be aware for the diagnosis
Summary
Small bowel diverticula are sac like protrusions of the bowel wall consisted of mucosal, submucosal and serosa without muscularis layer [1]. It’s a rare disease [2] with an unknown incidence and prevalence and non-specific clinical presentation. The most common symptom is chronic mild abdominal pain and discomfort [3]. Malabsorption and anemia are even rarer manifestations of the disease [4]. In the case of complicated diverticula symptoms depend on specific complications. Hemorrhage, perforation, acute diverticulitis and intestinal obstruction could be fatal complications [5]. A case of a 72-year-old man is described, with uncomplicated diverticula of the jejunum and multiple visits in the emergency department, due to mild abdominal pain
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