Perforated jejunal diverticulum: a rare presentation of acute abdomen

Abstract

SUMMARYJejunal diverticulosis is a rare entity with a reported clinical incidence of 0.5%. However, symptoms relating to its presence are non-specific, which does not only delay diagnosis, but also increases the risk of serious complications approaching 15%. We report a case of perforated jejunal diverticulum presented with a 6-month history of significant weight loss and acute abdominal pain. We discuss clinical presentation in both simple and complex cases, diagnostic pitfalls and management strategies. BACKGROUND

Perforated Diverticulum of the Proximal Jejunum with Abscess

“…It is postulated that they develop as a consequence of peristaltic dyskinesia which in turn leads to high intraluminal pressure which causes herniation of the mucosa and submucosa. This occurs on the antimesenteric border [3].…”

“…During the diverticular process stasis and bacterial overgrowth are prominent hence hyperbilirubinaemia can occur both via malabsorption and by bacterial mediated deconjugation. Bacteria also release siderophores and up regulate hepcidin, which can cause anaemia [3].…”

“…Jejunal diverticula are a rare, acquired entity. They are usually asymptomatic [1][2][3][4][5][6][7]. When symptomatic they present with chronic non specific symptoms like pain, nausea and malnutrition but they may also present as an acute abdominal emergency.…”

Perforated isolated jejunal diverticulum: a rare cause of acute abdomen

“…Only 15% of cases develop acute complications like intestinal obstruction, haemorrhage, diverticulitis and as seen in our case study, perforation. 8 Clinical diagnosis of jejunal diverticula perforation is difficult as the symptoms mimic other causes of acute abdomen like appendicitis, perforated peptic ulcer, sigmoid diverticulitis and ischemic bowel disease. 9 The literature has shown computed tomography scan has a variable reliability, while barium swallow is gold standard in making diagnosis.…”

Large jejunal diverticular faecolith causing small bowel obstruction: a bizarre cause of an acute abdomen

“…2 Small bowel diverticulosis is thought to result from a combination of intestinal dyskinesia and abnormal peristalsis causing high segmental intraluminal pressures. 3 This results in herniation of the mucosa and sub mucosa on the mesenteric border at points of weakness where blood vessels enter the bowel wall. In the small bowel, duodenal diverticula are five times more common than jejunal diverticula; however, the complication rate is five times higher in the latter.…”