Acute pancreatitis with pancreatic abscess secondary to sealed jejunal diverticular perforation

Abstract

Although most cases of acute pancreatitis are attributed to gallstones or alcohol, many remain idiopathic. The authors describe a case of acute pancreatitis in a 75-year-old gentleman who presented with acute epigastric pain, fevers and shortness of breath. Serum amylase was 2164. CT showed free mesenteric air, and a partly cystic/partly gas-containing mass in the uncinate lobe of the pancreas. Gastrograffin meal revealed duodenal and jejunal diverticular disease, but no contrast leak. Further CT analysis pinpointed fine tracts of air leading from a jejunal diverticulum up toward the pancreas, suggesting causation by a sealed jejunal diverticular perforation. He responded well to intravenous antibiotics and conservative management. Although small bowel diverticular disease is linked to chronic pancreatitis, evidence for association with acute pancreatitis is scarce. The authors believe this is the first reported case of jejunal diverticular disease causing acute pancreatitis, and it highlights micro-perforation as a potential disease mechanism.

Coexistent widespread small intestinal and colonic diverticular disease

“…Acute symptoms include inflammation, perforation and peritonitis, intestinal obstruction, haemorrhage, abscess formation and fistulation 9. Jejunal diverticulosis has also been linked to both acute and chronic pancreatitis as air tracts from the diverticulae to the pancreas have been demonstrated radiologically 10. The diagnosis is often unrecognised and ultimately made at the time of operation leading to increased morbidity and mortality 11.…”

Spontaneous perforated duodenal diverticulum: a case series

“…Back pain, like in our first case, can be a possible presentation due to this retroperitoneal localisation. The association with pancreatitis is rare, to our knowledge only 1 case has described the association of acute pancreatitis and a duodenal diverticulum perforation (5). Non-perforated duodenal diverticula, on the other hand, are known to be a possible cause of acute pancreatitis.…”