Alexander Ramirez Valderrama, MD, Paryush Lakhtaria, MD, Howard Tiszenkel, MD, FACS. New York Hospital Queens.
Introduction Small bowel diverticula are rare entities and usually asymptomatic. They are incidentally found on abdominal CT scan or during surgery. Complications such as bleeding, intussusception, obstruction, perforation, diverticulitis and volvulus have been reported. Diverticulitis associated with septic shock rarely complicates small bowel diverticulosis. We report a case of small bowel diverticulitis requiring urgent surgical intervention.
Case Report A 65-year-old male with no previous surgery presented to our Emergency Department with sudden onset of pain in suprapubic region and left lower quadrant associated with high fever and chills. On examination he was febrile, tachycardic, normotensive with suprapubic and left lower quadrant tenderness, guarding and peritoneal signs. His WBC count was 18,000 and CT scan of abdomen and pelvis showed giant jejunal diverticulitis (Figures 1, 2, 3). After the patient was resuscitated and started on broad-spectrum antibiotics, he underwent exploratory laparotomy. Intra operative findings showed giant jejunal diverticulum with inflammation and not abscess (Fig. 4). At surgery the diverticulum had a narrow neck, it was resected by transverse placement of TA stapler at its non-inflamed base (Fig.5). Upon opening the specimen, multiple enteroliths were revealed (Fig. 6). He had an uneventful recovery and he was discharge from the hospital on post op day 3. Pathology of specimen showed transmural necrosis of diverticulum and enteroliths.
Conclusion Although jejunal diverticulosis and its complications are rare, it should be considered in the differential diagnosis of intra-abdominal sepsis and of chronic abdominal pain, especially in older patients. Awareness of the wide spectrum of presentation and potential complications of small bowel diverticulosis can prevent delay in diagnosis. CT scan is the prefered diagnostic test for complicated small bowel diverticular disease.