Jejunal diverticulitis

Abstract

ABSTRACT Introduction: Although diverticular disease of the duodenum and colon is frequent, the jejuno–ileal diverticulosis is an uncommon entity. Presentation of case: A 70-year-old woman presented with a left upper quadrant pain evolving for 24 h associated with vomiting. Physical examination revealed an abdominal tenderness on left upper quadrant. Laboratory exams revealed an increased white blood cell count. The CT of the abdomen demonstrated a round lesion containing faecal-like material mixed with gas depending on the jejunum in the left side of abdomen associated with densification of the adjacent mesentery fat. The diagnosis of uncomplicated jejunal diverticulitis was suspected. The patient underwent six days of antibiotics. Two weeks later, a prophylactic diverticulectomy was performed. Histopathological examination showed diverticula on the jejunum with focal necrosis. The post-operative course was uneventful. Discussion: Diverticular disease can be widespread in the small bowel. Jejuno–ileal diverticula do not have pathognomonic clinical symptoms and they often present with non-specific symptoms. Complications of JD include perforation, abdominal abscesses, acute intestinal obstruction and diverticular bleeding. Diagnosis is often difficult and is confirmed mainly by imaging studies and CT is the modality of choice. There is no consensus on therapeutic strategy. There are different therapeutic approaches depending on the severity of the disease and the general clinical condition of the patient going from the conservative management with bowel rest and a broad-spectrum antibiotic to the surgery with intestinal resection. Conclusion: Jejunoleal diverticulitis should be always kept in mind as a cause of abdominal pain in the elderly patient. The management is based on surgery. The resection of the affected intestinal segment with primary anastomosis prevents recurrences. Highlights

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