Contained Perforation of a Jejunal Diverticulum in an Elderly Patient: A Case Report

Jejunal diverticulosis is an uncommon condition, and its complications-such as perforation-pose a diagnostic and therapeutic challenge, particularly in elderly patients. Contained perforation is especially difficult to identify due to its non-specific clinical presentation and subtle radiological findings. We report the case of an 82-year-old woman with a medical history of atrial fibrillation, heart failure, chronic obstructive pulmonary disease (COPD), and irritable bowel syndrome. She presented to the emergency department with a two-day history of diffuse abdominal pain, nausea, vomiting, and diarrhea. Physical examination revealed abdominal distension and tenderness in the epigastric and mesogastric regions, without signs of peritoneal irritation. Laboratory tests showed leukocytosis and impaired renal and hepatic function. Although initial imaging studies suggested a possible bowel obstruction, a non-contrast-enhanced abdominopelvic computed tomography (CT) scan was diagnostic. It demonstrated multiple jejunal diverticula, one of which exhibited an elongated morphology, wall thinning, and adjacent mesenteric fat stranding-findings consistent with a contained perforation. Due to persistent symptoms despite conservative management, an exploratory laparotomy was performed. Intraoperatively, a perforated jejunal diverticulum was identified 90 cm distal to the ligament of Treitz. A 5 cm segmental small bowel resection was performed, followed by a stapled side-to-side anastomosis with a functionally end-to-end configuration. The postoperative course was uneventful, and the patient was discharged on postoperative day four with favorable outpatient follow-up. This case underscores the importance of considering complicated jejunal diverticulitis in the differential diagnosis of acute abdominal pain in elderly patients, even in the presence of atypical clinical findings. A non-contrast CT scan was essential for the early identification of the contained perforation, allowing for timely surgical intervention and a favorable outcome. A high index of clinical suspicion is crucial in this patient population to avoid potentially fatal diagnostic delays.