TABLE 1 : Reported Cases of Jejunal Diverticular Perforation in the Past 10 Years , Summary
Patient Details Age , Years 66.1 ( 16.5 ) Gender , % Male 58.6 % ( 17 / 29 ) Peritoneal Sign Generalized 28 % ( 7 / 25 ) Localized 28 % ( 7 / 25 ) Negative 44 % ( 11 / 25 )
Chief Complaint Abdominal Pain 100 % ( 29 / 29 ) Fever 17 % ( 5 / 29 ) Nausea / Vomiting 10.3 % ( 3 / 29 )
Imaging Abdominal CT 85.7 % ( 24 / 28 ) Abdominal X-ray 32.1 % ( 9 / 28 )
Treatment Surgery Total 82.8 % ( 24 / 29 ) Laparotomy : Resection of Involved Jejunum 87.5 % ( 21 / 24 ) Laparotomy : Diverticulectomy 4.2 % ( 1 / 24 ) Laparotomy : Primary Suture Closure 4.2 % ( 1 / 24 ) Laparoscopic Resection of Involved Jejunum 4.2 % ( 1 / 24 )
Conservative Antibiotic Therapy 17.2 % ( 5 / 29 ) Hospital Stay ( Days ) 9.3 ( 8.4 ) Outcome Discharge 96.3 % ( 26 / 27 )
Death 3.7 % ( 1 / 27 )
CT : Computed Tomography Scan Note : Categorical variables reported as percentage ( count ) and quantitative variables reported as mean ( standard deviation ).
is similar to a hernia , where peristalsis leads to increased intraluminal intestinal pressure within the entry of a blood vessel , which is a vulnerable part of the intestinal wall . This theory is supported by the fact that diverticula occur more frequently in the area of mesenteric attachment and are more common in the upper jejunum , where the straight artery is larger than in the ileum . 9 Various causes of jejunal perforation have been reported , including accidental ingestion of a foreign body , trauma , and long-term use of nonsteroidal anti-inflammatory drugs , but the majority of cases are associated with worsening diverticulitis . 10 The pathological findings in our case included penetrating inflammation with necrosis in the diverticulum , consistent with signs of worsening diverticulitis .
Preoperative diagnosis of jejunal diverticular perforation is difficult because the abdominal symptoms are vague and nonspecific . On imaging , small bowel diverticula may be seen . One may also see the telltale signs of perforation with pneu-
FIGURE 1 : Abdominal Computed Tomography Scan
Pneumoperitoneum with stranding of fat in the left mid-abdomen about the transverse colon and contiguous with the jejunum , consistent with perforated jejunal diverticulum .
West Virginia Medical Journal • December 2023 • 25