Abstract

Jejunal diverticulae are a rare phenomenon that is usually asymptomatic but can present with chronic abdominal pain or as an acute abdomen when complicated by intestinal diverticulitis, obstruction, haemorrhage or perforation. The clinical presentation is often atypical and therefore diagnosis occurs at surgical intervention or occasionally during an imaging investigation. Surgical resection of the affected bowel segment with primary anastomosis is the preferred treatment of choice in complicated jejunal diverticulosis. We present a case of 94-year-old lady with an atypical presentation of complicated jejunal diverticulosis. She presented with acute abdomen, signs and symptoms suggestive of acute small bowel obstruction in the absence of specific diagnostic features of complicated jejunal diverticulae on the plain abdominal X-ray and CT imaging. Exploratory laparotomy revealed multiple jejunal diverticulae with several concealed perforations at the mesenteric border, distal to which an impacted jejunal enterolith was thought to have caused the small bowel obstruction. She made an uncomplicated recovery following small bowel resection of the affected perforated segment and a primary anastomosis. This case highlights the unusual mixed presentations of this rare entity and the importance of considering small bowel diverticulosis as a possible differential of acute abdomen especially in the elderly.

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