A Rare Cause of Acute Abdomen: Jejunal Diverticulosis with Perforation
A 74-year-old female patient was admitted to the Emergency Room with sudden onset of abdominal pain, nausea, and vomiting. Her physical examination revealed diffuse abdominal tenderness and abdominal rebound tenderness. Her laboratory tests were normal, except for elevated white blood cell count (WBC 13200/mm≥). Abdominal X-ray image in upright position showed two gas fluid lesions in the small intestine []. A computed tomography (CT) scan with intravenous (IV) contrast revealed multiple diverticula on the mesenteric wall of the small intestine and dilated intestinal loops proximal to the diverticula, but no free air or fluid []. Due to the acute symptoms, exploratory laparotomy surgery was performed. Multiple diverticula were seen located between 40th and 100th cm distal to the ligament of Treitz. A necrotic, perforated diverticulum was present in the distal part of the jejunal segment []. The 60-cm long jejunal segment was excised and end-to-end anastomosis was performed. The patient did not experience any postoperative complications, recovered completely and was discharged on Day 7. Histopathological examination showed multiple diverticula on the small intestinal wall closer to the mesenteric side as well as necrosis and a 5-mm perforation hole on one of the diverticula. The area of perforation was filled with fibrinous exudate. The diverticula were false diverticula, and only the mucosa and submucosa were herniated.