Small bowel diverticula in elderly patients: a case report and review article

An Unusual Presentation of Jejunal Diverticulitis Mimicking Acute Cholecystitis

Jejunal diverticulosis is a rare entity and jejunal diverticulitis is even rarer. Here we review a patient who presented with right upper quadrant pain and elevated white blood cell count, mimicking acute cholecystitis, as well as thrombocytopenia (21x10^3/mcl). The patient was managed non-operatively with antibiotics and had improvement in symptoms and thrombocytopenia. Our study highlights the importance of maintaining jejunal diverticulitis in the differential for right upper quadrant pain, and its association with severe thrombocytopenia.

Emergent Laparotomy Reveals Possible Meckel's Diverticulum: A Case Report

Small bowel obstruction (SBO) remains the most common diagnosis encountered by general surgeons, with 70% of cases related to adhesions from previous abdominal surgeries. Less common etiologies include Crohn's disease, gallstone ileus, and Meckel's diverticulum (MD). While MD is the most common congenital anomaly of the gastrointestinal tract, it is less frequently considered as a cause in adults. Nonetheless, it remains crucial to consider MD as a potential cause of SBO in adults, especially when evaluating patients with unexplained SBO and recurrent idiopathic abdominal pain, especially in those without a history of abdominal surgery. We present a case of a 74-year-old male presenting with right upper quadrant abdominal pain, constipation, and bilious vomiting, with a presumed diagnosis of SBO and perforation, potentially attributed to MD. This case highlights the differential challenges posed by small bowel diverticula and their complications, underscoring the need for vigilance in recognizing these complications and optimizing clinical management.

Small Bowel Diverticulosis and COVID-19: Awareness Is the Key: A Case Series and Review of the Literature

Small bowel non-Meckelian diverticulosis is a rare condition with only a few published cases despite being described over 200 years ago. In the midst of the COVID-19 pandemic, studies suggested that many patients may experience gastrointestinal manifestations. Intestinal symptoms could worsen the inflammation and infection associated with small bowel diverticulitis. Here we present three cases: one with inflammation and rupture in a COVID-19 patient and another as an asymptomatic detection. The third case involved recurrence after the first laparoscopic lavage approach. Furthermore, we provide a mini-review of the literature to emphasize the importance of considering this entity in the differential diagnosis of an acute abdomen. In the majority of cases involving small bowel diverticula, conservative management is the preferred approach. However, when complications arise, surgical intervention, including enteroctomy and primary anastomosis, may be necessary to achieve optimal outcomes.

Isolated Perforation of Multiple Jejunal Diverticulae: A Very Rare Cause of Acute Abdomen

Isolated jejunal diverticular (JD) perforation is extremely rare; it usually presents as a diagnostic dilemma and is often discovered incidentally on laparotomy. Most of these perforations are single. Literature has revealed only one case of multiple small bowel diverticular perforations. We report the first case of simultaneous perforation of four jejunal diverticulae in an 85-year-old male. Small bowel resection and primary anastomosis were performed. The patient had an uneventful post-operative recovery. This case highlights the importance of prompt diagnosis and timely management to reduce the morbidity and mortality of these patients. It should be included in the differential diagnosis in all elderly patients presenting with acute abdomen.

Perforated jejunal diverticulum as an unsual cause of acute abdomen: A case report

INTRODUCTION AND IMPORTANCE

Jejunal divertica is a rare entity with an often clinically silent course. However, it may be associated to life-threatening complications such as perforation. Therefore it should be considered in every case of acute abdomen.

CASE PRESENTATION

A 60-year-old female presented with a generalized abdominal pain associated with vomiting evolving for 24 h. Physical examination found an irreducible and tender hernia in the umbilical region with abdominal guarding. Laboratory test results showed a biological inflammatory syndrome. The primary diagnosis of strangulated umbilical hernia was suspected and the patient underwent an emergency laparotomy. Intra-operative examination revealed mutiple jejunal diverticula, with a perforation in one diverticulum leading to generalized peritonitis. A bowel resection and peritoneal lavage were performed with good outcome.

CLINICAL DISCUSSION

Jejunal diverticula is a challenging condition with various non-specific clinical presentations. Jejunal perforation is its most feared complication. Deceitful abdominal examination among elderly patients and lack of specific signs may lead to diagnostic delay responsible for high mortality rate and poor prognosis. Adjunctive imaging modalities may be needed to help establish a prompt diagnosis and dictate management strategy. Treatment of perforated jejunal diverticulum is based on limited bowel resection associated to primary anastomosis.

CONCLUSION

Jejunal diverticulitis should be kept in mind as a differential diagnosis in every case of acute abdomen. High index of clinical suspicion and eventual further radiological examinations are required to avoid misdaignosis and save patients' lives.