Perforated isolated jejunal diverticulum: a rare cause of acute abdomen

Authors

  • Abhijeet Jha Department of Surgery, Maulana Azad Medical College, New Delhi, India
  • Deepak Ghuliani Department of Surgery, Maulana Azad Medical College, New Delhi, India
  • Sudhir K. Jain Department of Surgery, Maulana Azad Medical College, New Delhi, India
  • Faiz M. Ansari Department of Surgery, Maulana Azad Medical College, New Delhi, India

DOI:

https://doi.org/10.18203/2349-2902.isj20195993

Keywords:

Jejunal, Diverticulum, Perforation

Abstract

A 45-year-old female presented with pain in peri-umbilical region for past one day along with history of non-bilious vomiting and non passage of stool and flatus for past one day. On physical examination, patient was afebrile, mild dehydration was present, tachycardia of 102 beats per minute with normal blood pressure. On clinical examination, the abdomen was diffusely tender with rebound tenderness. Bowel sounds were absent. Laboratory investigations revealed leucocytosis. An erect plain chest X-ray was done, didn’t reveal any gas under the diaphragm. Contrast enhanced computed tomography abdomen was done which showed a hollow viscus perforation with intra-abdominal free air and pelvic free fluid. Patient was resuscitated with IV fluid, broad-spectrum antibiotics were started and immediately taken up for exploratory laparotomy. Three jejunal diverticula identified at mesenteric border, with pin-head perforation in one of the diverticula. Small bowel resection including the three diverticula and primary end-to-end anastomosis was performed. Post-operative period was uneventful. Patient discharged on satisfactory conditions. This case stresses the importance to consider this entity in cases of unexplained gastrointestinal symptoms because any treatment delay may lead to unsuccessful clinical outcome.

References

Tsiotos GG, Farnell MB,Ilstrup DM. Nonmeckelian jejunal or ileal diverticulosis: an analysis of 112 cases. Surg. 1994;116:726-31.

Noer T. Non-Meckelian diverticula of the small bowel. The incidence in an autopsy material. Acta Chir Scand. 1960;25:175-9.

Newton RC, Penney N, Nind N, Sajid MS, Sains P. Small bowel malignant melanoma presenting as a perforated jejunal diverticulum: a case report and literature review. Gastroenterol Rep (Oxf). 2016;4:80-3.

Soemmering ST, Baille M. Anatomie des krankhaften Baues von einigen der wichtigsten Teile im menschlichen Korper. In: Vossiche Buchhandlung; Berlin: 1974.

Lempinen M, Salmela K, Kemppainen E. Jejunal diverticulosis: a potentially dangerous entity. Scand J Gastroenterol. 2004;39(9):905-9.

Cooper A. Anatomy and Surgical Treatment of Crural Umbilical Hernia. Longman, 1807.

De Bree E, Grammatikakis J, Christodoulakis M, Tsiftsis D. The clinical significance of acquired jejunoileal diverticula. Am J Gastroenterol. 1998;93:2523-8.

Kavanagh C, Kaoutzanis C, Spoor K, Friedman PF. Perforated jejunal diverticulum: a rare presentation of acute abdomen. BMJ Case Rep. 2014;22:2014.

Gliustra PE, Killoran PJ, Root JA, Ward WW. Jejunal diverticulitis. Radiology 1977;125:609-11.

Chugay P, Choi J, Dong XD. Jejunal diverticular disease complicated by enteroliths: Report of two different presentations. World J Gastrointest Surg. 2010;2(1):26-9.

Levack MM, Madariaga ML, Kaafarani HM. Non-operative successful management of perforated small bowel diverticulum. World J Gastroenterol. 2014;20:18477-9.

Herrington JL. Jr perforation of acquired diverticula of the jejunum and ileum: Analysis of reported cases. Surgery. 1962;51:426-33.

WH Peranteau, Smink D.Appendix, Meckel’s and other small bowel diverticula. In: Zinner, ed. Maingot’s abdominal operations: McGraw Hill; 2012: 643.

Kassir R, Boueil-Bourlier A, Baccot S, Abboud K, Dubois J, Petcu CA, et al. Jejuno-ileal diverticulitis: etiopathogenicity, diagnosis and management. Int J Surg Case Rep. 2015;10:151-3.

Baski A, Gupta S, Kumar S, Ray U. Perforated isolated jejunal diverticulum: a rare aetiology of acute abdomen. BMJ Case Rep. 2014;11:2014.

Makris K, Tsiotos GG, Stafyla V, Sakorafas GH. Small intestinal nonmeckelian diverticulosis: clinical review. J Clin Gastroenterol. 2009;43:201-7.

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Published

2019-12-26

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Case Reports