Complicated jejunal diverticulosis – a rare but important diagnosis to consider in abdominal pain: a report of three cases

Abstract

Jejunal diverticulosis, a form of acquired false diverticula, is considered to be a rare clinical entity, which is mostly asymptomatic. But, in case of complications, jejunal diverticulosis can present as acute abdominal distress. Due to its rarity in clinical manifestation, jejunal diverticulosis may lead to a diagnostic and therapeutic delay. We report on 3 interdisciplinary cases of complicated jejunal diverticulosis by diverticulitis, diverticular bleeding, and perforation. We want to highlight the fact that complicated jejunal diverticulosis should be considered as a differential diagnosis in cases of unclear abdominal pain.

Perforated diverticulitis in a patient with very proximal jejunal diverticula

“…sclerosis, amyloidosis) or not, that leads to high segmental intraluminal pressure [5,9,10,12,18]. DJ is usually an asymptomatic disorder or causes chronic unspecific symptoms, like intermittent postprandial abdominal pain, nausea, vomiting, borborygmi, alternating diarrhea and constipation, anemia, malabsorption and weight loss [1][2][3]5,6,9,10,12,18]. A triad has been described by Edwards in such patients as "flatulent dyspepsia: epigastric pain, abdominal discomfort, flatulence one or two hours after meals" [10,12].…”

“…In case of CDJ, the patients are seriously ill and this should be taken under consideration when deciding the proper emergent management, especially since this condition affects more frequently the elderly [1,3,5,7,9,12,16,18,20]. As a result of its rarity and diffuse symptomatology, often masking other disorders, CDJ is a challenging acute condition from the diagnostic perspective [1,3,6,18]. Still today, diagnosis of CDJ is most frequently confirmed intraoperatively, sometimes after considerable delay that increases morbidity and mortality [3,5,9,11,18].…”

“…www.journalofgastricsurgery.com 103 Background Diverticulosis jejuni (DJ) is a very rare condition, and complicated diverticulosis jejuni (CDJ) is even rarer [1][2][3][4][5][6][7][8]. The clinical incidence of small intestine diverticula ranges from 0.06% to 1.3% [5,9,10], but results of contrast studies and autopsies showed an incidence of 0.5%-4.6% [3,5,[9][10][11][12].…”

“…Intestinal diverticula are pseudodiverticula of the pulsion type, they are usually multiple and mostly located in the proximal jejunum [4,5,9,13]. DJ is usually asymptomatic or may cause unspecific long-standing symptoms with a variable periodicity and severity [1,3,5,6,9,10]. Related complications, such as diverticulitis, hemorrhage, perforation and obstruction appear in about 10-30% of the patients, and increase morbidity and mortality [1,[3][4][5][6][7][8][9]12,[14][15][16][17].…”

“…DJ is usually asymptomatic or may cause unspecific long-standing symptoms with a variable periodicity and severity [1,3,5,6,9,10]. Related complications, such as diverticulitis, hemorrhage, perforation and obstruction appear in about 10-30% of the patients, and increase morbidity and mortality [1,[3][4][5][6][7][8][9]12,[14][15][16][17]. Herein, we report a rare case of a 92-year old woman who had severe comorbidities, presented with peritonitis and in septic shock due to a jejunal diverticulum adjacent to the ligament of Treitz, inflamed and perforated in the mesentery, but was lucky to have a prompt diagnosis and a successful surgical treatment, along with a brief review of the literature.…”