JEJUNAL DIVERTICULITIS: AN UNUSUAL PRESENTATION OF ACUTE ABDOMEN

Abstract

Jejunal diverticula are rare and often incidentally discovered. The most common complication is jejunal diverticulitis, which is frequently overlooked and not routinely considered as a differential diagnosis of acute abdomen because of the location of the diverticula, the patient’s age and the rarity of the disease. Computed tomography (CT) is the imaging modality of choice for diagnosis and evaluation of its extent and complications. We present a 64-year-old woman with a history of progressive abdominal pain, constipation and fever, where jejunal diverticulitis was diagnosed based on CT findings. The CT scan displayed a large, thickened wall, inflammatory mass containing gas and feces-like material adjacent to a jejunal loop, with surrounding inflammatory reactive changes, as well as a few smaller noninflamed diverticula at different levels of the small bowel. The patient was hence diagnosed with uncomplicated jejunal diverticulitis and managed conservatively with complete recovery. The purpose of this article is to illustrate a case of jejunal diverticulitis, as well as to review the current literature regarding the epidemiology, pathogenesis, clinical features, radiologic findings and management of this condition.

Downloads

Download data is not yet available.

References

1. Coulier B, Maldague P, Bourgeois A, Broze B. Diverticulitis of the small bowel: CT diagnosis. Abdominal Imaging. 2006;32(2):228-233. doi:10.1007/s00261-006-9045-8.

2. Transue DL, Hanna TN, Shekhani H, Rohatgi S, Khosa F, Johnson J-O. Small bowel diverticulitis: an imaging review of an uncommon entity. Emergency Radiology. 2016;24(2):195-205. doi:10.1007/s10140-016-1448-4.

3. Peuter BD, Box I, Vanheste R, Dymarkowski S. Small-bowel Diverticulosis: Imaging Findings and Review of Three Cases. Gastroenterology Research and Practice. 2009;2009:1-3. doi:10.1155/2009/549853.

4. Chow DC, Babaian M, Taubin HL. Jejunoileal diverticula. Gastroenterologist. 1997;5(1):78-84.

5. Kassahun WT, Fangmann J, Harms J, Bartels M, Hauss J. Complicated small-bowel diverticulosis: a case report and review of the literature. World Journal of Gastroenterology. 2007;13(15):2240. doi:10.3748/wjg.v13.i15.2240.

6. Kasper DL, Fauci AS, Hauser S, et al, editors. Harrison’s principles of internal medicine, 19th ed. 1971-1973

7. Ross CB, Richards WO, Sharp KW, Bertram PD, Schaper PW. Diverticular disease of the jejunum and its complications. Am Surg. 1990;56(5) 319-324. PMID: 2110429.

8. Gotian A, Katz S. Jejunal diverticulitis with localized perforation and intramesenteric abscess. The American Journal of Gastroenterology. 1998;93(7):1173-1175. doi:10.1111/j.1572-0241.1998.00357.x.

9. Kassir R, Boueil-Bourlier A, Baccot S, Abboud K, Dubois J, Petcu C et al. Jejuno–ileal diverticulitis: Etiopathogenicity, diagnosis and management. International Journal of Surgery Case Reports. 2015;10:151-153. doi:10.1016/j.ijscr.2015.03.044.


10. Liu CY, Chang WH, Lin SC, Chu CH, Wang TE, Shih SC. Analysis of clinical manifestations of symptomatic acquired jejunoileal diverticular disease. World Journal of Gastroenterology. 2005;11(35): 5557–5560. doi:10.3748/wjg.v11.i35.5557



11. Lebert P, Ernst O, Zins M. Acquired diverticular disease of the jejunum and ileum: imaging features and pitfalls. Abdominal Radiology. 2019;44(5):1734-1743.

12. Harbi H, Kardoun N, Fendri S, Dammak N, Toumi N, Guirat A et al. Jejunal diverticulitis. Review and treatment algorithm. La Presse Médicale. 2017;46(12):1139-1143. doi:10.1016/j.lpm.2017.08.009.

13. Macari M, Faust M, Liang H, Pachter H. CT of jejunal diverticulitis: imaging findings, differential diagnosis, and clinical management. Clinical Radiology. 2007;62(1):73-77. doi:10.1016/j.crad.2006.09.014.

14. Hoeffel C, Crema M, Belkacem A, Azizi L, Lewin M, Arrivé L et al. Multi–Detector Row CT: Spectrum of Diseases Involving the Ileocecal Area. RadioGraphics. 2006;26(5):1373-1390. doi:10.1148/rg.265045191.

15. Veen M, Hornstra BJ, Clemens CH, Stigter H, Vree R. Small bowel diverticulitis as a cause of acute abdomen. European Journal of Gastroenterology & Hepatology. 2009;21(1):123-125. doi:10.1097/meg.0b013e328303bfdb.
Published
2022-12-15
How to Cite
ALVES, Ana Sofia et al. JEJUNAL DIVERTICULITIS: AN UNUSUAL PRESENTATION OF ACUTE ABDOMEN. Revista Portuguesa de Cirurgia, [S.l.], n. 53, p. 99-103, dec. 2022. ISSN 2183-1165. Available at: <https://revista.spcir.com/index.php/spcir/article/view/789>. Date accessed: 17 june 2024. doi: https://doi.org/10.34635/rpc.789.
Section
Clinical Case