AB206. SOH26AB_0226. Perforated jejunal diverticulitis, a rare abdominal pathology: a case report

Background: Small bowel diverticulosis is thought to occur in approximately 0.3% to 2.3% of patients, presenting with nonspecific abdominal symptoms. In 10–20% of these cases, complications such as diverticulitis or perforation occur. The duodenum is more commonly associated with diverticula, with jejunoileal diverticula being a rarer phenomenon. We present a case of a 69-year-old patient who presented with acute abdominal pain, subsequently diagnosed as a perforated jejunal diverticulitis.

Case Description: A 69-year-old female presented with a 3-day history of a sudden onset of left iliac fossa pain with reduced oral intake and nausea. Initial blood investigations revealed inflammation and leukocytosis. A plain film abdomen revealed centrally located small bowel loops, prompting a computed tomography (CT) abdomen and pelvis (AP). The CT AP showed a complex mesenteric orientation and a dilated small bowel loop. Pelvis magnetic resonance imaging (MRI) was performed for further characterisation and demonstrated an extraluminal collection within the central pelvis which communicated with a mildly dilated loop of ileum, consistent with a small bowel perforation. The patient then proceeded to surgery. A laparoscopic-assisted small bowel resection was performed, removing approximately 30 cm of jejunum containing multiple diverticula, including one perforated diverticulum. A side-to-side stapled jejunojejunal anastomosis was created. Post-operatively, the patient made a full recovery and was discharged 9 days post-surgery.

Conclusions: Perforated jejunal diverticulitis is an uncommon cause of acute abdominal pain and may present with radiologically challenging findings. This case highlights the importance of maintaining a broad differential and timely surgical interventions.

Keywords: Jejunal diverticulosis; perforated diverticulitis; small bowel; imaging; case report