S2969 Abdominal Pain: A Silent and Unlikely Cause

Abstract

Introduction: While diverticulosis is commonly found in the large intestine it is a rare disease found in the small intestine accounting for only 0.06-1.3% of cases. Although most cases are asymptomatic, roughly 30-40%, it is crucial that it is on the differential of acute abdominal pain as it can be life threatening and potentially require surgical management. Case Description/Methods: On initial visit to the emergency room a 61 year old Hispanic male was found to have a perforated jejunal diverticula on Computed Tomography (CT) scan after initially presenting with left upper quadrant abdominal pain. He had a past medical history of hypertension and Helicobacter pylori (H. Pylori) gastritis found on esophagogastroduodenoscopy (EGD) in 2019. His past surgical history was significant for an exploratory laparotomy 25 years ago secondary to a gunshot wound in his right upper quadrant. The pain initially began in his left upper quadrant and progressed to diffuse abdominal pain. He was hemodynamically stable, afebrile and saturating well on room air. A CT scan was performed in the emergency department which displayed a perforated duodenal ulcer at the distal 3rd/4th segment of the duodenum with small surrounding retroperitoneal air and mild fat stranding. He was admitted under the surgery department and taken to the operating room. Upon dissection of the duodenum, approximately 5cm from the ligament of Treitz, a microperforation was seen which was consistent with a mesenteric jejunal diverticulum. Discussion: Jejunal Diverticulosis is a rare phenomena that can lead to life threatening complications. As most cases are asymptomatic and often miss diagnosed it is imperative that physicians consider it as a differential when the diagnosis of abdominal pain or acute abdomen is presented.Figure 1.: What was thought to be a perforated duodenal ulcer and a thin wisp of contrast adjacent to three extraluminal foci of gas, denoted by the yellow arrow, which turned out to be a perforated jejunal diverticula visualized during surgery.