Jejunal Diverticulitis, an Unusual Cause of a Surgical Abdomen

Uncommon and usually silent, small bowel diverticulosis (SBD) is rarely discussed in the surgical literature. Symptomatic SBD most commonly occurs in the jejunum and can lead to serious complications not readily elicited from the history and physical. Given its location within the mesentery, SBD is poorly visualized both radiographically and intraopertively. We present the case ofa 53 year old male who was initially misdiagnosed with bacterial enteritis on computed topography and admitted to Internal Medicine for bowel rest and antibiotic therapy. General surgery was consulted three days later for peritonitis and the patient was found to have jejunal diverticulitis. He successfully underwent surgical resection with primary anastomosis. In our review of the literature, few complications of SBD are correctly diagnosed pre-operatively. The result is a delay in diagnosis and increased morbidity and mortality. There have been mixed results regarding the use of antibiotics in these patients, therefore the authors feel strongly that resection of the diseased segment is still the gold standard for definitive treatment. This case illustrates several key challenges in the diagnosis and management of the disease.