Abdominal Wall Abscess Associated with Perforated Jejunal Diverticulitis: Report of a Case

Abstract

We report a case of abdominal wall abscess caused by diverticulitis of the jejunum penetrating through the abdominal wall. A 53-year-old Japanese woman visited a local hospital complaining of abdominal pain and a mass in the left lower abdomen. An abdominal computed tomography scan showed a tumor with isodensity in the left lower abdominal wall. Magnetic resonance imaging showed a mass in the abdominal wall with isointensity in the T1-intensified image and high intensity in the T2-intensified images. The mass was heterogeneous inside and protruded partially toward the intraperitoneal cavity. Ultrasound examination showed a heteroechoic mass extending into the intraperitoneal cavity. Laparotomy revealed a tumor in the abdominal wall with a fistulous tract extending to the jejunum. We resected the abdominal wall tumor with partial resection of the small intestine. The resected specimen contained a tumor with a fistulous tract passing through the abdominal wall. Histological examination revealed remarkable infiltration of neutrophils and a bacterial mass in the abdominal wall tumor, with a fistulous tract connected to the area adjacent to the mesenteric border of the jejunum. These findings suggested that diverticulitis of the jejunum had penetrated through the abdominal wall, leading to the formation of an abscess. We report this case to highlight the need for complete gastrointestinal evaluation with gastrointestinal barium studies and imaging analysis to examine extension of intra-abdominal lesions in patients with an unexplained abdominal wall abscess.

Abdominal Wall Abscess due to Acute Perforated Sigmoid Diverticulitis: A Case Report with MDCT and US Findings

“…Such intra-abdominal diseases include acute appendicitis, gynecological disorders, Crohn's disease, diverticula of the colon, cholecystitis, and perforation of the intestine. Finally, other AWA may also be caused by iatrogenic causes like placement of catheters, foreign bodies, or rudiments of the urachus [2]. To the best of our knowledge, there is not a recent systematic record of AWA reporting the exact percentage of every cause resulting to AWA.…”

“…Perforation of the colon can usually form a diffuse phlegmonous infiltration, a local abscess, or a colovesical fistula [1]. In some rarer cases, extra-abdominal spread of the inflammation process and abscess formation in the abdominal wall may be observed [2]. …”

Jejunal Diverticulitis: A Rare Case of Severe Peritonitis

“…Jejunoileal diverticuli are mostly asymptomatic, but malabsorption due to bacterial overgrowth within them may be a major clinical feature. They may also present in unusual ways, such as with a gastrointestinal hemorrhage due to a ruptured congenital arteriovenous malformation in the diverticular submucosal [13], perforation with abscess progressing into a jejuno- [14] ileo- [15] abdominal wall fistula formation, or episodes of bowel obstruction secondary to volvulus [16], stricture formation [17] or an enterolith impaction [18,19,20]. Jejunal diverticulitis occurs in about 2-6% of cases and has a mortality rate as high as 24% [11].…”

Robotic neo‐rectopexy: a technique for repair of neo‐rectal prolapse following transanal total mesorectal excision – a video vignette

“…Dear Editor, There have been six reported cases of jejunoileal diverticulitis causing an abdominal wall abscess [1][2][3][4][5][6]. To the best of our knowledge, this is the first case of jejunal diverticulitis complicated with abdominal wall fistula and iliac bone osteomyelitis.…”