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.