Perforated solitary giant true jejunal diverticulum

Abstract

Jejunal diverticula are rare and usually asymptomatic. However, they may cause chronic non-specific symptoms or rarely lead to an acute presentation. Here, we report a rare case of a child presenting with a perforated congenital jejunal diverticulum. We report a case of 10-year-old female who presented with severe acute abdominal pain, repeated vomiting, hypotension, and tachycardia of 1 day duration. Chest X-ray showed free air under diaphragm and abdominal X-ray displayed dilated bowel loops. Laboratory investigations showed leukocytosis and hyperamylasemia. After intravenous (IV) fluid resuscitation, diagnostic laparoscopy was performed that detected the presence of perforated solitary giant jejunal diverticulum, about 25 cm from the duodenojejunal junction, in addition to diffuse peritonitis. We had to convert to laparotomy due to the presence of huge amount of undigested food particles. Resection of the diverticulum-bearing segment and anastomosis was done along with thorough peritoneal decontamination and washout. Solitary giant jejunal diverticulum is a rare condition which can present with chronic vague abdominal pain and altered bowel habits, and can present acutely with complications as perforation with significant morbidity.