Case Report
Jejuno-ileal diverticulitis: A disorder not to underestimate

https://doi.org/10.1016/j.ijscr.2019.04.015Get rights and content
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Highlights

  • In the paper a rare case of complete and well documented jejunal diverticulitis complicated with perforation and peritonitis is described.

  • Interesting radiological and intraoperative imaging are attached.

  • A carefull and recent literature review has been performed in order to discuss diagnosis and management of jejuno-ileal diverticula and our clinical behavior.

  • From the discussion emerges that the possibility of the presence of small bowel diverticula must be considered in case of occult bleeding non-indentifiable with gastroscopy or colonoscopy.

  • Therapeutic behavior is suggested in case of acute peritonitis due to jejunal diverticula or in case of incidental diagnosis.

Abstract

Introduction

Jejuno-ileal diverticulitis is an uncommon, acquired clinical entity, with higher prevalence among patients aged between 60 and 70. The condition is usually silent and has been regarded as relatively innocuous. Sometimes patients complain chronic vague symptoms like malabsorption, pain or nausea, that easily lead to misdiagnosis. Acute complications are rare, however, they have been reported and can result in major surgery and high overall mortality.

Case report

We are presenting a case of a 67-year-old patient who presented to our department with abdominal pain and signs of peritonitis. The CT scan displayed an inflammatory mass with a fair amount of free liquid in the abdomen, as well as multiple diverticula at different levels of the intestine. The patient had to underwent immediate surgery, during which a resection of 25 cm jejunum and 80 cm of ileum has been performed.

Conclusion

Jejuno-ileal diverticula are a very uncommon finding that can present formidable challenges in diagnosis and treatment. The course can be completely asymptomatic, however, in rare cases, the condition can lead to severe complications that often require surgery. Multi detector CT (MDCT) with intravenous contrast should always be the modality of choice for investigating a suspect of small bowel diverticula. There are no specific guidelines respect the management of jejuno-ileal diverticulitis, nevertheless, in the acute setting, bowel resection is the treatment of choice.

As well as setting out the rarity of this case, our work intends to review the current literature regarding the epidemiology, natural history, diagnosis and management of jejuno-ileal diverticula

Keywords

Case report
Emergency surgery
Diverticulitis
Jejuno-ileal diverticula
Adhesiolisis
Peritonitis

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