DISCUSSION:
Acquired small bowel diverticulum corresponds to a herniation of the intestinal mucosa and submucosal through penetration sites of vasa recta, which represent weak points of intestinal wall. Unlike congenital Meckel’s diverticulum, there is no muscular layer in the diverticular wall. It is a rare condition (1 to 4.6%) that occurs usually between 60 and 70 years[3].
The most frequent complication is diverticulitis. Two factors were incriminated in its genesis: the stasis of the jejunum contents in the diverticulum and the mucosal edema with subsequent obstruction of the diverticular neck [3–5]. However, the diverticulitis is much less common in the jejunum than in colonic diverticula probably because of diverticulum larger size, better intra-luminal flow and lower concentration of bacteria [3].
The perforation of jejunal diverticulum is rare (2.1 to 7% of diverticulitis), probably because of intestinal intraluminal low pressures [3,6].
Non complicated cases can be clinically silent or may mimic irritable bowel syndrome symptoms: chronic abdominal pain, bloating sensation after food intake, abdominal cramping of unexplained cause and diarrhea [6]. In case of diverticulitis, symptoms are similar to an acute peritonitis secondary to perforated duodenal ulcer.
On CT scan, jejunal diverticula are shown as round structures outside of the small bowel lumen and containing some combination of contrast material, air, and debris. The large jejunal diverticula can be distinguished from adjacent small-bowel loops by their different contents and by the absence of conniving valvulae [7]. Frequent findings seen in diverticulitis are an inflammatory mass which may contain gas, wall thickening of an involved segment, edema of the surrounding tissues and fluid collection [1,5].
Non perforated jejunal diverticulitis is managed conservatively with antibiotics, intravenous fluids, and bowel rest [8,9]. For perforated jejunal diverticula, surgery is mandatory. The recommended technique is resection of the involved intestinal segment. [3,7,10]. In case of multiple diverticulum (like our patient), resection should be performed only for complicated one. The anastomosis can be performed only in the absence of generalized peritonitis and septic shock, and it should be done on intestinal segments without diverticula.