Uncomplicated jejunal diverticulosis with pneumoperitoneum

Abstract

Small bowel diverticulosis is a rare finding within all bowel diverticuloses and jejunal diverticulosis is even rarer. Their relative clinical rarity and varied presentation may make diagnosis both delayed and difficult. We experienced a case of jejunal diverticulosis, which was diagnosed intraoperatively. A 55-year-old woman was admitted to Emergency Department with pneumoperitoneum on plain chest and abdominal film from a local clinic. She was hemodynamically stable with minimal tenderness on the left upper quadrant of the abdomen but no rebound tenderness. At surgery, small bowel torsion and jejunal diverticulosis were confirmed. Over 30 variable sized small bowel diverticula were noted on the mesenteric side of the proximal jejunum. The affected segment of the jejunum was about 180 cm. On exploration, we could not find any perforation site. No postoperative complications were observed, and the patient made a full recovery. Jejunal diverticulosis is rare, but it should not be regarded as insignificant.

Jejunal Diverticulitis Mimicking Small Bowel Perforation: Case Report and Review of the Literature

“…However, rarely it can be found without obvious perforation or signs of peritonitis. The physiopathological mechanisms are thought to be a rapidly closed leaking diverticulum (microperforation) and the transmural passage of air through a thin-walled diverticulum (semipermeable membrane) (16). In our patient the small amount of extraluminal air along with his clinical condition and the signs of peritonitis lead to the diagnosis of small bowel perforation and to surgical intervention, although on laparotomy no obvious perforation of a diverticulum existed.…”

Small Bowel Diverticulosis Causing Pneumoperitoneum without Peritonitis: A Case Report

“…As a consequence, mucosa and submucosa herniate through the weakest points of the bowel wall which is the mesenteric border where vasa recta pierce the muscularis layer resulting in pulsion or pseudo diverticulum. 6,8 Small bowel diverticulosis affects individuals above 40 years with male to female ratio 2:1. 13 Prevalence increases with age, with majority being detected in sixth or seventh decade.…”

“…13 Prevalence increases with age, with majority being detected in sixth or seventh decade. 6 Most cases (around 80%) remain asymptomatic. 14 When symptomatic, they can present with chronic epigastric or periumbilical abdominal pain (especially postprandial pain), constipation, diarrhea, and malabsorption.…”

“…17 Chronic complications due to small bowel diverticulosis includes malabsorption, blind loop syndrome, enterolith formation, jejunal dyskinesia, chronic diverticulitis, and chronic recurrent pneumoperitoneum without peritonitis. 6,18 Diverticular perforation is one of the serious complications which can present with peritonitis. Most often peritonitis caused by perforation of small bowel diverticulosis is localized, contained and self-limiting as the mesentery walls them off.…”

“…3,4 Small bowel diverticulosis can also cause chronic/repetitive pneumoperitoneum without peritonitis through the micro perforations in the wall of the diverticula as a result of hyperactive peristaltic activity or due to transmural passage of air through the markedly thinned out wall of the diverticulum. 5,6,7 We report a case of small bowel diverticulosis which presented with pneumoperitoneum without bowel perforation or peritonitis.…”