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
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.
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..