Complicated Jejunal Diverticulosis as a Rare Cause of Small Bowel Perforation in an Immunocompromised Patient: A Case...

Jejunal diverticulosis is an uncommon and often underrecognized condition that may lead to life-threatening complications, particularly in immunocompromised patients. Among these, perforation remains an uncommon but critical event, with variable clinical presentations depending on the degree of peritoneal contamination. We present the case of a 74-year-old male with a history of renal transplantation on chronic immunosuppressive therapy who presented with acute abdominal pain, fever, and diarrhea. Laboratory findings were consistent with systemic inflammation and poor nutritional status. Contrast-enhanced abdominal CT demonstrated a saccular outpouching in the proximal jejunum, mesenteric pneumatosis, and contained extraluminal contrast leakage, suggestive of complicated jejunal diverticulitis. Exploratory laparotomy revealed a jejunal perforation directed toward the mesenteric border, with intestinal content leakage confined to the mesentery and no evidence of free intraperitoneal contamination. Segmental resection with primary anastomosis was performed, resulting in a favorable postoperative course. This case highlights the importance of recognizing contained jejunal perforation as a distinct clinical entity, particularly in immunocompromised patients, in whom early diagnosis and timely surgical management are essential to prevent progression and improve outcomes.