Akademik Veri Yönetim Sistemi
10. ULUSLARARASI İSTANBUL BİLİMSEL ARAŞTIRMALAR KONGRESİ, İstanbul, Türkiye, 23 - 25 Temmuz 2022, ss.598-600
A RARE PATHOLOGY IN THE ETIOLOGY OF
ABDOMINAL PAIN: JEJUNAL DIVERTICULUM
ABSTRACT
Jejunoileal diverticulosis is a rare condition and the course of the disease is mostly asymptomatic.
It is rarely encountered with acute complications. In this case report, a 49-year-old male patient who
presented to the emergency department with acute appendicitis and was found to have asymptomatic
jejunal diverticulum during abdominal exploration during appendectomy is presented.
Keywords: Jejunal diverticulum, acute abdomen, asymptomatic
INTRODUCTION
Although the diverticular disease is mostly a colonic pathology, the incidence of mesenteric diverticula
in the proximal jejunum is very low. Although they are generally asymptomatic, they can cause chronic
nonspecific symptoms and sometimes acute abdomen. Although most of these patients do not require
surgical treatment, complications such as bleeding, perforation, obstruction or persistent abdominal pain
may develop. In the presence of complications, the recommended treatment is segmental small bowel
resection and anastomosis involving the diverticulum (1). We present a case of jejunal diverticulum that
we operated on for acute appendicitis and discovered incidentally.
CASE REPORT
We present a 49-year-old male patient who presented with a one-day history of abdominal pain
and vomiting. On radiological imaging, the small intestines were slightly dilated and free fluid in the
abdomen was seen. By listening, bowel sounds were hypoactive, and there was tenderness and defense in
the entire abdomen on palpation. Rectal examination was unremarkable. Vital parameters were normal.
In laboratory examination, white blood cell value was high and other parameters were normal. There
were several air-fluid levels and gas shadows at the level of the small intestine on the standing direct
abdominal X-ray. Free fluid was detected in the abdomen on ultrasonography (USG).
Our patient underwent laparotomy. On exploration, it was observed that there were diffuse free
fluid and occasional abscesses in the abdomen, in the right lower quadrant of the abdomen, and the
rectovesical space. There was no bile or intestinal contents in the abdomen. Perforation was seen at
the root of the appendix. Appendectomy and extensive washing were performed. Exploration revealed
one diverticulum located on the mesenteric face in the proximal jejunum (Figure 1). He was discharged
uneventfully on the 8th postoperative day following antibiotic treatment.
DISCUSSION
Non-Meckelian small bowel diverticula were first found at autopsy by Sir Astley Cooper in 1807 (2).
80% of these diverticula were seen in the jejunum, 15% in the ileum, and 5% in both parts (3). In this
case, jejunal diverticulum was present. Many sizes of small bowel diverticulum have been presented in
he literature. In general, diverticula in the jejunum are larger than those in the ileum (2). It is thought
hat small intestinal pseudodiverticula develop as a result of the contraction disorder that occurs after
motor dysfunction of the myenteric plexus or muscle layer, increased intestinal intraluminal pressure,
and as a result, herniation of the submucosa and mucosa from the weak point on the mesentery side
where the vessels enter the intestine (4). They may be diverticular congenital or acquired due to traction.
n our case, we think that it was acquired because of the location.
Jejunoileal diverticula are usually asymptomatic. The diagnosis is often made incidentally during
aparotomy or various radiological imaging studies. To a lesser extent, they present with acute
complications or chronic symptoms. This case was discovered by chance during exploration while being
operated on with the diagnosis of acute appendicitis. No treatment is recommended for asymptomatic
ejunal diverticula. In the presence of acute complications, segmental resection and primary anastomosis
are sufficient. Local resection of the diverticulum is not recommended (1). In this case, an appendectomy
was performed, but the diverticulum was left intact. The reason why resection was not considered in the
case was that no perforation or inflammation was detected.
CONCLUSION
The jejunal diverticulum is a difficult and rare condition to diagnose. No standard recommended
oadmap has been reported for the follow-up and treatment of jejunal diverticulum. Asymptomatic cases
do not require treatment. In the presence of complications, segmental resection and primary anastomosis
may be preferred.
REFERENCES
Dirican A, άnal B, Sόmer F, Baώsόllό N, Φzgόr D, Kύrύmlύoπlu V. Dev Soliter Jejunal Divertikόl Perforasyonu.
2009;16(1):53–5.
Kanat BH, Yur M, Erol F, Φzcan S, Bozan MB, Yazar FM. A rare cause of peritonitis; jejunal diverticulitis: case
report. SiSli Etfal Hastan Tip Bul / Med Bull Sisli Hosp. 2013;(4):209–11.
Kassahun WT, Fangmann J, Harms J, Bartels M, Hauss J. Complicated small-bowel diverticulosis: a case report
and review of the literature. World J Gastroenterol WJG. 2007;13(15):2240.
De Peuter B, Box I, Vanheste R, Dymarkowski S. Small-bowel diverticulosis: imaging findings and review of
three cases. Gastroenterol Res Pract. 2009;2009.