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A Case of Perforated Jejunal Diverticulum: An Unexpected Cause of Pneumoperitoneum in a Patient Presenting with an Acute Abdomen

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

DOI: 10.12659/AJCR.909131


BACKGROUND: 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.

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