Mesenteric Volvulus from Jejunal Diverticulosis

Jejunal Diverticulitis: A Rare Diverticular Disease of the Bowel

Diverticulosis is an out-pocketing of the bowel wall that can affect the small bowel through the large bowel. Small bowel diverticulosis is rare and not as common as colonic diverticulosis, which is an important diagnosis for hospitalizations. Moreover, jejunal diverticulosis is rare among cases of small bowel diverticulosis. Jejunal diverticulitis is one of the complications of jejunal diverticulosis that can be conservatively managed with antibiotics instead of surgery.

We report a case of a 41-year-old African American man who presented with vague epigastric pain and was diagnosed with adhesive jejunal diverticulitis upon contrast-enhanced computed tomography of the abdomen. The patient did not develop any life-threatening complications such as perforation or peritonitis, and recovered after conservative management with antibiotics. Adhesive jejunal diverticulitis with fat stranding was the distinctive finding in our patient, as he might have had multiple asymptomatic episodes.

Initial diagnostic modalities include radiography and contrast-enhanced computed tomography. Enteroclysis is the most reliable and accurate diagnostic modality, but is not available in all urgent settings. Recently, endoscopy has replaced radiological studies. Conservative management is adequate for uncomplicated cases of jejunal diverticulitis. However, surgical intervention is required in most cases of complicated jejunal diverticulosis, or mortality rates will be high.