Via Research Recognition Day Program VCOM-Carolinas 2025

Educational Reports

Perforated Proximal Jejunal Diverticulitis in an Elderly Female: A Case of Emergent Diagnosis and Laparoscopic Surgical Resolution Kelly Champlin, DO MS, Holden Lewis OMS-III, Anthony Chaknis OMS-III, Kendra Saint Martin OMS-IV, Austin McCrea DO, Mia Klein MD HCA Grand Strand Medical Center, Myrtle Beach, SC; Edward Via College of Osteopathic Medicine, Spartanburg, SC; Rocky Vista College of Osteopathic Medicine, Rocky Vista, CO

Specimen

Operation cont.

Background

▪ Proximal diverticula incidence is 0.06%-1.3% ▪ Usually asymptomatic in elderly ▪ Complicated features drastically increase mortality ▪ Management usually includes IV antibiotics, percutaneous drainage or laparotomy ▪ Must keep on differential in geriatric patients with acute abdominal symptoms ▪ 72-year-old female with medical history of type 2 diabetes and hypertension presented with peritonitis. ▪ The patient described a 3 day history of LUQ pain with associated nausea. ▪ Labs and vital signs were significant for tachycardia to rate of 140 and leukocytosis of 22,000. ▪ Imaging via CT abdomen and pelvis of revealed abnormal left jejunal small bowel loop with contained perforation alongside marked mesenteric inflammation. Operation ▪ Subsequent emergent laparoscopic exploration identified small bowel interloop abscesses and dense reactive adhesions. ▪ Following meticulous dissection, the perforation was found situated closely to Ligament of Treitz and arising from a large jejunal diverticulum on the mesenteric side. Case Presentation

▪ Incidental findings included an adjacent diverticulum and mesenteric cyst. ▪ Small bowel resection was performed, and an extra corporeal primary side-to-side stapled anastomosis was completed without complication. ▪ This minimally invasive operation included three 5 mm port sites, with one upsized to 12 mm to facilitate utilization of laparoscopic stapler and another extended to 2.5 cm to conduct the anastomosis. ▪ Final pathology revealed two benign large adjacent jejunal diverticula, with one showing signs of necrosis and perforation along the mesenteric border, as well as an ancillary mesenteric cyst. ▪ Post operative course was uneventful besides a small bowel ileus ▪ The patient was discharged home on post-op day 6

Conclusion

▪ This case emphasizes the importance of prompt recognition and decisive management in the infrequent presentation of perforated proximal diverticulitis ▪ Even in the setting of bowel perforation and peritonitis, further underscored is the role of a laparoscopic approach which ultimately attributed to this patient’s favorable outcomes and quick recovery.

References

1.

Abdelhalim D, Kania T, Heldreth A, Champion N, Mukherjee I, Kania TA, Champion NT. Operative management of perforated jejunal diverticulitis. Cureus. 2022 Jan 17;14(1). Staszewicz W, Christodoulou M, Proietti S, Demartines N. Acute ulcerative jejunal diverticulitis: case report of an uncommon entity. World journal of gastroenterology: WJG. 2008 Oct 10;14(40):6265. Alam S, Rana A, Pervez R. Jejunal diverticulitis: imaging to management. Ann Saudi Med. 2014 Jan Feb;34(1):87-90. doi: 10.5144/0256-4947.2014.87. PMID: 24658563; PMCID: PMC6074925.

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