Acute abdomen secondary to perforated jejunal diverticulitis: an unusual clinical presentation - case report

Jejunal diverticulosis is an uncommon condition, usually asymptomatic that could lead to severe complications such as perforation, associated with high mortality, and its presentation can mimic other acute abdominal or even urologic disorders, often requiring urgent surgery for both diagnosis and treatment.

A 68-year-old woman with no significant medical history presented with sudden-onset severe colicky pain in the left lumbar and iliac regions, initially resembling renal colic. Laboratory tests revealed leukocytosis and elevated CRP. A non-contrast abdominal CT ruled out nephrolithiasis but demonstrated ileal wall thickening, peridiverticular gas, and inflammatory changes. Emergency laparotomy revealed 200 mL of purulent free fluid, a jejunal loop adherent to the left flank and a 0.5-cm perforation in the jejunum, 20 cm distal to the ligament of Treitz. Segmental resection with primary anastomosis was performed. Histopathology confirmed multiple jejunal diverticula with one perforated. The patient had an uneventful recovery and was discharged on postoperative day six.

The clinical manifestations of jejunal diverticulitis are often nonspecific and may mimic appendicitis, cholecystitis, colonic diverticulitis, or urologic disease, as in this case. Although CT is the diagnostic modality of choice, its sensitivity is limited, and definitive diagnosis often requires surgical exploration. Segmental resection with primary anastomosis remains the treatment of choice in perforated cases.

Although rare, perforated jejunal diverticulitis is a life-threatening entity. Clinicians should maintain a high index of suspicion in patients with atypical presentations of acute abdomen. Early surgical intervention is essential to improve outcomes.