Jejunal Diverticulosis: Two Case Reports of Life- Threatening Complications

Nadia Van Den Berg1*, Maeve O’Neill1, Conor Keady1, Aoife Canney2 and Myles Joyce1

1Department of Surgery, Galway University Hospital, Republic of Ireland
2Department of Pathology, Galway University Hospital, Republic of Ireland

^*Correspondance to: Nadia Van Den Berg 

 PDF  Full Text DOI: 10.25107/2474-1647.3358

Abstract

Background: Small bowel diverticulosis is an incidental finding in 1% to 7% of the general population. Jejunal diverticula occur less frequently; reported in 0.2% to 1.3% on autopsy. Most cases are asymptomatic; however a subgroup may present with life-threatening complications including perforation, hemorrhage, diverticulitis, mesenteric abscess or obstruction. Methods: We describe two cases of jejunal diverticulosis with severe complications requiring surgical intervention. We include a review of the literature relating to this disease, including epidemiology, presentation, diagnosis, complications, and management. Case 1: The first case describes a 57-year-old male presenting with an unstable gastro-intestinal hemorrhage; with unidentifiable source on endoscopy. Exploratory laparotomy revealed that the life-threatening gastrointestinal hemorrhage was originating from jejunal diverticula. A small bowel resection incorporating the jejunal diverticulum achieved hemostasis. Several days later when the patient had stabilized a stapled with end-to-side stapled anastomosis was performed with a successful outcome. Case 2: The second case is a 77-year-old female presenting with an acute abdomen and a perforated viscus on computed tomography; however, the source of perforation could not be identified radiologically. Emergency diagnostic laparoscopy revealed perforated jejunal diverticulitis with an associated abscess. A small midline laparotomy incision with extracorporeal small bowel resection and end-to-side stapled anastomosis was performed. Conclusion: Jejunal diverticular disease is most often an incidental finding at laparoscopy or laparotomy. However a small percentage may present with life-threatening complications that are difficult to diagnose clinically. Although uncommon in the general population; jejunal diverticulum complication should be kept in the differential diagnoses for patients presenting with abdominal pain, an acute abdomen, gastrointestinal hemorrhage in which the most common pathologies have been excluded.

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Cite the article

Van Den Berg N, O’Neill M, Keady C, Canney A, Joyce M. Jejunal Diverticulosis: Two Case Reports of Life-Threatening Complications. Clin Surg. 2021; 6: 3358..