A Case of Perforated Jejunal Diverticulum: An Unexpected Cause of Pneumoperitoneum in a Patient Presenting with an Acute Abdomen
Challenging differential diagnosis, Rare disease
Bruno Augusto Alves Martins, Rosana Rodrigues Galletti, Júlio Marinho dos Santos Neto, Caroline Neiva Mendes
School of Medicine, University of Brasília, Brasília, Brazil
Am J Case Rep 2018; 19:549-552
Jejunal diverticulosis is a rare clinical condition, and the majority of patients are asymptomatic. However, some patients can develop serious complications, including perforation. We report the case of a 74-year-old female patient with a perforated jejunal diverticulum who presented with an ‘acute abdomen’ and with pneumoperitoneum on X-ray radiography.
CASE REPORT: A 74-year-old female patient presented to the emergency department with a 24-hour history of acute onset of diffuse abdominal pain associated with nausea and vomiting. Physical examination showed signs of generalized peritonitis. The chest radiograph showed a pneumoperitoneum. An emergency laparotomy was performed, and a perforated jejunal diverticulum was identified. Resection of the involved jejunal segment and a primary jejunal anastomosis were performed.
CONCLUSIONS: Perforated jejunoileal diverticula should be included in the differential diagnosis for elderly patients who present with an acute abdomen. A delay in the diagnosis can be fatal in this group of patients. Although radiographic signs, such as pneumoperitoneum, are unusual in these cases, this finding should provide a diagnostic clue for the physician.
Keywords: diverticulitis, Diverticulum, Jejunal Diseases, Pneumoperitoneum