Jejunal diverticulitis in a healthy 91-year-old man

Abstract

A 91-year-old African American man was admitted with sudden onset diffuse abdominal pain which radiated to the right flank. CT of the abdomen with contrast showed diverticula in the jejunum with adjacent inflammation and microperforation that was contained. Conservative therapy similar to colonic diverticulitis was effective. Although rare, our case highlights the importance of having an early and high suspicion for jejunal diverticulitis when patients present with non-specific abdominal symptoms in order to avoid perforation.

Isolated perforated jejunal diverticulitis: a case report

“…Non-operative management of uncomplicated small bowel diverticulitis with antibiotic therapy and bowel rest has previously been reported [ 10 ]. However, cases of complicated diverticulitis have largely been managed by operative management with resection and primary anastomosis the predominant approach.…”

Perforated jejunal diverticula in a young woman: A case report

“…Despite true diverticula like the Meckel’s diverticulum, all diverticula are considered to be acquired pseudodiverticula; mucosal and submucosal protrusion through the muscular tissue of the gastrointestinal tract [ 1 , 6 , 11 ]. Their exact etiology remains unknown.…”

Jejunal Diverticulosis Complicated by Diverticulitis and Small Bowel Obstruction

“…The risk of jejunal diverticulosis increases with age, with the reported median age of 72 to 82 years [9]. Patients with jejunal diverticulosis are often asymptomatic, though up to 40% of patients with jejunal diverticulosis have abdominal pain, changes in bowel habits, and malabsorption [2]. Complications of jejunal diverticulosis, estimated to occur in 10% of patients with jejunal diverticulosis, are serious, and potentially life-threatening, including jejunal diverticulitis, hemorrhage, obstruction, and perforation [1,2,5].…”

“…We presented a unique case of jejunal diverticulosis with two sequential complications: jejunal diverticulitis and small bowel obstruction. While the American Society of Colon and Rectal Surgeons recommends non-operative treatment for uncomplicated sigmoid diverticulitis and consideration of elective colectomy after the patient recovers from an episode of complicated diverticulitis (including perforation, abscess, fistula, obstruction, or stricture), there is no consensus for small bowel diverticulitis management, particularly in patients with chronic symptoms [2,10,11]. Some providers believe patients with chronic symptoms can be treated conservatively if the inflammation is mild [11][12][13].…”

“…Patients are usually asymptomatic and diagnosed incidentally on radiographic imaging. In a minority of patients, jejunal diverticulosis can manifest with clinical symptoms and develop serious complications, including diverticulitis, hemorrhage, intussusception, small bowel obstruction, or perforation [2]. We herein present a case of an elderly female who presented with acute abdominal pain and found to have jejunal diverticulitis that was complicated by small bowel obstruction with resultant surgical resection.…”