A Rare Case of Multiple Jejunal Diverticulosis Presenting as Intestinal Obstruction
A 54-year old male patient presented himself at the Emergency Department with extensive abdominal pain and multiple episodes of bilious vomiting for the previous two days. The patient had a history of multiple episodes of pain and occasional fullness in the upper abdomen for the previous three years. The patient had earlier taken a complete course of anti-tubercular treatment empirically based on features of recurrent intestinal obstruction at other medical centers on the pretext of the prevalence of tuberculosis in this region. On presentation, the patient was found to be hemodynamically stable. Abdominal examination showed distension in the epigastric and umbilical regions with localized tenderness and hyperactive bowel sounds.\nLaboratory work-up revealed raised blood urea and serum creatinine. Contrast enhanced computed tomography was, therefore, not performed but erect and supine abdominal radiograpghs revealed multiple air fluid levels () and dilated jejunal loops (), respectively.\nA diagnosis of acute intestinal obstruction was made after which an emergency exploratory laparotomy was performed. This revealed multiple inflamed diverticulae () in the jejunum with a band 15 cm from ligament of Treitz. The largest diverticulum was 5x4x4 cm at the mesentric border () with multiple adhesions () in jejunum and proximal ileum forming a blind loop. Pin-point pus exudation was seen from one of the diverticulum (). A segmental resection of two and half feet of jejunum with end-to-end jejuno-jejunostomy was performed after removing all the bands and adhesions. The patient’s post-operative course was uneventful and the patient was discharged on Day 10 after surgery. The histopathological examination of the specimen showed focal mucosal ulceration with sub-mucosal edema and chronic inflammatory infiltrate, whereas multiple sections taken from diverticulae exhibited features of diverticulitis along with an area of stricture.