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We report a case of an elderly with peritonitis due to perforated jejunal diverticulitis, and we highlight the diagnostic evaluation and treatment alternatives.
Case presentation:
A 92-year-old woman was transferred to the Emergency Dept. with abdominal pain and vomiting for the past 12 hours. Physical examination revealed diffuse pain, abdominal distension, rebound tenderness and bowel silence. She was febrile, tachycardic, tachypneic, hypotensive and anuric. Blood gas estimation showed metabolic acidosis. She fulfilled the criteria of septic shock. At presentation, she was mildly malnourished.
From her medical history, she had cardiac arrythmias, hypertension and diabetes mellitus under proper medication, and laparoscopic cholecystectomy. Laboratory investigations revealed Hct 44.6%, WBC 12.500/dL, glucose 300 mg/dL, creatinine 2.8 mg/dL, CRP 405 mg/L, and electrolyte deficit. Abdominal X-ray showed gastric, small intestinal and colonic gas, with no pneumoperitoneum or air-fluid levels. Chest/abdomen CT showed thickening of proximal jejunal loop and adjacent mesentery, and an extraluminal air bubble, suggesting possible perforation. The patient was given intense resuscitation and broad-spectrum antibiotics and underwent emergency laparotomy.
Four jejunal diverticula, sized 1-3 cm, were confined to a segment 12 cm long, located 6 cm from the Treitz ligament; the proximal diverticula was inflamed and perforated. The adjacent mesentery was inflamed and thickened; the bowel lumen remained open. We performed one-layer full-thickness suturing of the perforated diverticulum and omental patch closure. The patient was transferred intubated to ICU. E. Coli was isolated from
peritoneal fluid cultures and antibiotic therapy was adjusted to antibiogram. The patient had a first bowel movement at day 5 and was extubated at day 21. She needed mild cardiopulmonary support and was discharged at day 30.
Jejunal diverticulitis is a challenging disorder since its rarity makes diagnosis difficult and, thus delayed. The perforation of jejunal diverticulitis requires emergent surgery and poses technical dilemmas.


jejunal diverticulitis perforation emergency surgery

Article Details

How to Cite
Avgoustou, C., & Velecheris, D. (2020). Perforated diverticulitis in a patient with very proximal jejunal diverticula. Journal of Gastric Surgery, 2(3), 102–105.


  1. Johnson KN, Fankhauser GT, Chapital AB, Merritt MV, Johnson DJ. Emergency management of complicated jejunal diverticulosis. Am Surg. 2014;80:600-3.
  2. Fidan N, Mermi EU, Acay MB, Murat M, Zobaci E. Jejunal diverticulosis presented with acute abdomen and diverticulitis complication: A case report. Pol J Radiol. 2015;80:532-5.
  3. Téoule P, Birgin E, Zaltenbach B, et al. A retrospective, unicentric evaluation of complicated diverticulosis jejuni: Symptoms, treatment, and postoperative course. Front Surg. 2015;2:57.
  4. Khan HS, Ayyaz M. Jejunal diverticulosis presenting as an acute emergency. J Coll Physicians Surg Pak. 2015;25 Suppl 1:S20-1.
  5. Mohi RS Ms, Moudgil A Ms, Bhatia SK Ms, Seth K Ms, Kaur T Ms. Complicated jejunal diverticulosis: Small bowel volvulus with obstruction. Iran J Med Sci. 2016;41:548-51.
  6. Walter BM, Winker J, Wagner M, Jung A, Strebel H, Born P. Complicated jejunal diverticulosis - a rare but important diagnosis to consider in abdominal pain: a report of three cases. Z Gastroenterol. 2016;54:562-5.
  7. Harbi H, Kardoun N, Fendri S, et al. Jejunal diverticulitis. Review and treatment algorithm. Presse Med. 2017;46(12 Pt 1):1139-43.
  8. Lebert P, Millet I, Ernst O, et al.Acute jejunoileal diverticulitis: Multicenter descriptive study of 33 patients. AJR Am J Roentgerol. 2018;210:1245-51.
  9. Kassir R, Boueil-Bourlier A, Baccot S, et al.Jejuno-ileal diverticulitis: Etiopathogenicity, diagnosis and management. Int J Surg Case Rep. 2015;10:151-3
  10. Aydın E, Yerli H, Avcı T, Yılmaz T, Gülay H. One of the rare causes of acute abdomen leading to subileus: Jejunal diverticulitis. Balkan Med J. 2016;33:354-6.
  11. Patel VA, Jefferis H, Spiegelberg B, Iqbal Q, Prabhudesai A, Harris S. Jejunal diverticulosis is not always a silent spectator: a report of 4 cases and review of the literature. World J Gastroenterol. 2008;14:5916-9.
  12. Falidas E, Vlachos K, Mathioulakis S, Archontovasilis F, Villias C. Multiple giant diverticula of the jejunum causing intestinal obstruction: report of a case and review of the literature. World J Emerg Surg. 2011;6:8.
  13. Horesh N, Klang E, Gravetz A, et al. Jejunal diverticulitis. J Laparoendosc Adv Surg Tech A. 2016; 26:596-9.
  14. Longo WE, Vernava AM 3rd. Clinical implications of jejunoileal diverticular disease. Dis Colon Rectum 1992;35:381-8.
  15. Chow DC, Babaian M, Taubin HL. Jejunoileal diverticula. Gastroenterologist 1997 ;5:78-84. PMID:9074921Wilcox RD, Shatney CH.Am Surg. 1990;56:222-5.
  16. Veen M, Hornstra BJ, Clemens CH, Stigter H, Vree R. Small bowel diverticulitis as a cause of acute abdomen. Eur J Gastroenterol Hepatol. 2009;21:123-5.
  17. França M, Certo M, Silva D, Peixoto C, Varzim P. Elderly patient with acute, left lower abdominal pain: perforated jejunal diverticulitis. Eur Radiol. 2010;20:2541-5.
  18. Natarajan K, Phansalkar M, Varghese RG, Thangiah G. Jejunal diverticulosis with perforation - a challenging differential diagnosis of acute abdomen: case report. J Clin Diagn Res. 2015;9:ED03-4.
  19. Levack MM, Madariaga ML, Kaafarani HM. Non-operative successful management of a perforated small bowel diverticulum. World J Gastroenterol. 2014;20:18477-9.
  20. López Marcano AJ, Ramia JM, De la Plaza Llamas R, Alonso S, Gonzales Aguilar JD, Kühnhardt Barrantes AW. [Complicated jejunoileal diverticular disease: a 12 cases' serie and literature review]. Rev Gastroenterol Peru. 2017;37:240-245.
  21. Macari M, Faust M, Liang H, Pachter HL. CT of jejunal diverticulitis: imaging findings, differential diagnosis, and clinical management. Clin Radiol. 2007;62:73-7.