Acute Jejunal Diverticulitis: A Case Report

Acquired small intestinal diverticulitis and its complications remain poorly understood due to their rarity and nonspecific presentation. Complications such as abdominal sepsis, bleeding, and perforation can lead to unfavorable outcomes. We report the case of a patient who presented with acute jejunal diverticulitis requiring surgical intervention. A 66-year-old man with a history of endovascular abdominal aortic aneurysm repair presented with acute left lower quadrant abdominal pain and tenderness. Computed tomography (CT) detected intestinal diverticulosis, localized free air, and inflammatory changes associated with the small intestine. Exploratory laparoscopy revealed numerous proximal jejunal diverticula with perforation contained within the mesentery. A 48 cm segment of the jejunum was resected, and a primary anastomosis was performed. Surgical pathology confirmed acute small intestinal diverticulitis and serositis. The patient had an uneventful postoperative course and was discharged home on postoperative day 6. This case highlights the diagnostic challenge in acute small intestinal diverticulitis, which may present with nonspecific signs and inconclusive radiological findings. The location of diverticula along the mesenteric border may contain perforations in the mesentery and obscure peritoneal signs. Although some patients with acute small intestinal diverticulitis may be conservatively managed, surgical intervention remains the standard of care for managing patients with complications. Acute small intestinal diverticulitis, though exceedingly rare, can carry a significant risk of morbidity and mortality. Thus, small intestinal diverticulitis should be considered in the differential diagnosis in older adults who present with acute abdominal pain and tenderness. Surgical management remains the gold standard of treatment of severe acute small intestinal diverticulitis.