CASE PRESENTATION:
A 74-year-old man with history of diabetes mellitus presented to the emergency department with a severe epigastric pain and vomiting for 24 hours. On examination, there was tenderness in epigastric region. Laboratory tests revealed elevated leukocytes (16300/mm3) and normal level of lipase.
CT scan showed multiple jejunal diverticula. One of the diverticula had a thickened enhancing wall with a surrounding significant inflammatory reaction and extraluminal gas bubbles suggestive of perforation. There was no abscess formation nor fluid collection (Figure 1).
Figure 1: CT scan showing diffuse jejunal diverticula (red arrow), thickened enhancing wall with a surrounding significant inflammatory reaction (yellow arrow) and extraluminal gas (blue arrow).
An urgent surgery was performed. During laparotomy, multiple large jejunal diverticula were found (Figure 2A). One of diverticula was frankly inflammatory with false membranes (Figure 2B: blue arrow) without obvious perforation, free fluid or abscess. A 50 cm intestinal resection removing this diverticulum was performed followed by a side-to-side mechanical anastomosis.
Figure 2: intraoperative findings: A- multiple jejunal diverticula.
B- Intraoperative findings: diverticula frankly inflammatory with false membranes (blue arrow) without obvious perforation, free fluid or abscess.
The postoperative course was uneventful and the patient was discharged on the 7th postoperative day.
The patient did not present any recurrence of pain at 12 months of follow-up.