A Case of Perforation of a Mesenteric Abscess due to Jejunal Diverticular Penetration

Abstract

A 91-year-old man presented to our hospital with abdominal pain and fever. Physical examination revealed localized tenderness in the right upper quadrant, without signs of peritoneal irritation. Contrast-enhanced abdominal computed tomography demonstrated a small amount of gas as well as increased fat attenuation within the small bowel mesentery, accompanied by adjacent free intraperitoneal air. We suspected a small bowel perforation and performed emergent laparoscopic-assisted surgery for both diagnostic and therapeutic purposes. Intraoperatively, a segment of the small intestine was found to be adherent to the right upper abdominal wall, and following adhesiolysis, a mesenteric purulent discharge originating from a jejunal diverticulum that was located 30 cm distal to the ligament of Treitz and had penetrated into the mesentery was identified. Thus, there was a mesenteric abscess that had perforated into the intestine and caused the intestinal segment to adhere to the abdominal wall. Following segmental resection of the affected jejunum, we performed a primary jejunojejunostomy. Postoperative histopathology confirmed mesenteric penetration and intestinal perforation secondary to diverticulitis of a jejunal pseudodiverticulum. The postoperative course was uneventful, and the patient was discharged on postoperative day 9. The clinical outcome in this patient suggests that even in super-aged patients, laparoscopic surgery can achieve favorable outcomes with omit minimal invasiveness.