A Preoperatively Diagnosed Case of Panperitonitis Caused by Penetration of the Jejunal Diverticulum

Abstract

A 56-year-old man complained of a 3-day history of epigastralgia and vomiting. He was admitted to our hospital because the pain had increased and had extended to his entire abdomen. Upon admission, tenderness and muscular defense across the entire abdominal region was observed. An enhanced abdominal CT scan revealed a gas-containing jejunal mesenteric abscess and multiple diverticula of the small intestine. The patient was diagnosed as having panperitonitis caused by penetration of the jejunal diverticulum in the mesentery. Emergency surgery revealed purulent ascites and a 9-cm jejunal mesenteric abscess. The mesenteric abscess was located about 35 cm distal from the ligament of Treitz and had perforated into the abdomen. We performed a partial resection of the jejunum. The resected specimen revealed a jejunal diverticulum penetrating the mesentery. With the exception of Meckel’s diverticulum, penetration or perforation of the small intestinal diverticulum is rare. This condition has a high mortality rate because it is difficult to diagnose preoperatively. We report herein on a case of panperitonitis caused by penetration of the jejunal diverticulum that was successfully diagnosed preoperatively.