Case report on a rare cause of small bowel perforation perforated ileal diverticulum

Complications due to small bowel non-Meckel's diverticulosis is an uncommon clinical scenario encountered in clinical practice. A diverticulum in the ileum is rare among the locations of the diverticulum in the small intestine. We describe an unusual case of ileal diverticular perforation presenting as an acute abdomen.

A 74-year-old male presented with septic shock and localized peritonitis in right lower abdomen. Preoperative imaging and intraoperative findings were consistent with terminal ileal diverticular perforation for which right hemicolectomy was done.

Small bowel diverticulosis was usually asymptomatic, though it can rarely present with acute abdominal emergencies. Computed tomogram of the abdomen, Barium meal follow-through, capsule endoscopy, CT enteroclysis can be used to diagnose small bowel diverticulosis. Although the incidence of small bowel diverticulosis is low, small bowel diverticulitis should be included in the differential diagnosis if an inflammatory mass involving the small bowel is demonstrated on CT. Patients with localized and self-limited inflammation without free perforation in imaging can be treated conservatively with parenteral antibiotics and close monitoring approach. Surgical intervention is usually required for complicated acute presentations and those with refractory symptoms. A high index of suspicion of complicated small bowel diverticulosis should be in the clinician's mind when dealing with acute small bowel emergencies especially in elderly patients.