Mid-jejunal diverticulitis with closed-loop bowel obstruction, strangulation, and contained perforation.

Area of Science:

• Gastroenterology
• Surgical Pathology
• Rheumatology

Background:

• Jejunal diverticulosis, characterized by sac-like outpouchings, can lead to serious complications including diverticulitis, obstruction, abscess, perforation, and fistula formation.
• Complicated jejunal diverticulosis often presents with non-specific symptoms of acute abdomen, potentially leading to misdiagnosis and delayed treatment.
• The association between polymyalgia rheumatica (PMR) and diverticular disease is an area requiring further research, with potential implications for treatment strategies.

Purpose of the Study:

• To highlight the rare presentation of acute on chronic jejunal diverticulitis with closed-loop bowel obstruction and contained perforation as a critical differential diagnosis for acute abdomen.
• To discuss the potential association between polymyalgia rheumatica and diverticular disease and its clinical implications, particularly regarding steroid therapy.

Main Methods:

• Case report of a 76-year-old male with a history of PMR presenting with acute abdominal symptoms.
• Diagnostic workup included physical examination, laboratory tests (leukocytosis, elevated inflammatory markers), and CT scan with IV contrast.
• Surgical intervention involved exploratory laparotomy and resection of the affected jejunal segment.

Main Results:

• CT scan revealed a contained perforation and closed-loop small bowel obstruction in the mid-abdomen.
• Pathology confirmed acute on chronic jejunal diverticulitis with numerous diverticula contributing to the obstruction and perforation.
• The patient's presentation underscores the importance of considering rare pathologies in acute abdomen cases.

Conclusions:

• Closed-loop bowel obstruction and contained perforation secondary to acute on chronic jejunal diverticulitis are rare but crucial considerations in the differential diagnosis of acute abdomen.
• The potential association between diverticular disease and PMR necessitates careful management, especially concerning the risk of diverticular perforation with glucocorticoid therapy for PMR.