Whole jejunoileal diverticulosis with recurrent inflammation and perforation: A case report

Yoshifumi Watanabe; Masaru Murata; Masashi Hirota; Rei Suzuki

doi:10.1016/j.ijscr.2021.106020

Whole jejunoileal diverticulosis with recurrent inflammation and perforation: A case report

Int J Surg Case Rep. 2021 Jul:84:106020. doi: 10.1016/j.ijscr.2021.106020. Epub 2021 May 27.

Authors

Yoshifumi Watanabe¹, Masaru Murata², Masashi Hirota³, Rei Suzuki⁴

Affiliations

¹ Department of Surgery, Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka, Japan. Electronic address: watanabe-yoshifumi@hoshigaoka.jcho.go.jp.
² Department of Surgery, Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka, Japan. Electronic address: murata-masaru@hoshigaoka.jcho.go.jp.
³ Department of Surgery, Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka, Japan. Electronic address: hirota-masashi@hoshigaoka.jcho.go.jp.
⁴ Department of Surgery, Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka, Japan. Electronic address: suzuki-rei@hoshigaoka.jcho.go.jp.

Abstract

Introduction: Jejunoileal diverticulitis is uncommon and poorly understood. We report a case of whole jejunoileal diverticulosis with recurrent inflammation and perforation.

Case presentation: A 72-year-old man with hemodialysis presented with fever and abdominal pain. The patient had a medical history of twice having jejunoileal diverticulitis. Serum testing indicated a white blood cell count of 15,670/μL and a C-reactive protein level of 10.31 mg/dL. Contrast-enhanced computed tomography showed jejunoileal diverticulosis with the concomitant mesenteric fat opacity and a 60-mm × 45-mm mass lesion containing extraluminal air bubbles. Jejunoileal partial resection was performed. Multiple diverticulosis was recognized over the entire jejunoileum, and the pouches existed along entry points of the bowel vascular supply through the mesentery. Intestinal resection was limited to the intestinal loop associated with complicated diverticulitis with abscess. Macroscopic examination revealed multiple jejunoileal diverticulosis. In the reddened mucosa, the diverticulitis and mesenteric perforation were recognized. Microscopic examination showed protrusion of mucosal and submucosal layers through a defect in the muscular layer with gangrenous inflammation. These findings supported a diagnosis of jejunoileal diverticulitis with perforation and abscess. The patient had no postoperative complications and no recurrence within 6 months.

Discussion: Treatment for jejunoileal diverticulitis should be individualized for each patient according to their degree of inflammation, recurrence, and the patient's background.

Conclusion: Extensive diverticulosis over the entire jejunoileum is very rare. In this case, the section of the inflamed diverticulosis can be distinguished and resected to avoid a short-bowel syndrome, which should lead to an uneventful postoperative course.

Keywords: Abscess; Diverticulitis; Hemodialysis; Jejunoileum; Perforation; Small intestine.