Perforated isolated jejunal diverticula: a rare cause of acute abdomen

A 45-year-old female presented to the surgery emergency department with complaints of pain in the whole abdomen, vomiting and non-passage of flatus and stools for the past one day. Physical examination revealed tachycardia with a normal blood pressure. The abdomen showed diffuse tenderness and guarding and bowel sounds were absent. After appropriate fluid resuscitation, the patient underwent a non-contrast computed tomography, which showed intra-abdominal free air. She was then prepared for exploratory laparotomy. Intraoperatively, three jejunal diverticula were identified at the mesenteric side, with perforation of the distal two. Segmental resection of the jejunum, including three diverticula, with primary end-to-end anastomosis was performed. Histopathology report confirmed the diagnosis of jejunal diverticula.

Jejunal diverticula are extremely rare and are usually asymptomatic. However, such presentation warrants their inclusion under the differential diagnosis of acute abdomen, albeit lower down the order. Isolated jejunal diverticular perforation is a rare complication and may present as a surprise intraoperative finding to the operating surgeon.