A Case of Perforated Multiple True Diverticula of the Small Intestine Associated with Intestinal Malrotation

Abstract

A 44-year-old man who had an inborn bowel habit comprising several diarrheas with abdominal distention a day presented with a three-day history of intensifying abdominal pain and abdominal distention. On physical examination, there were spontaneous pain and tenderness in the entire abdomen with the strongest point in the lower abdomen. A blood analysis showed a rise of inflammatory reaction and an abdominal CT scan revealed small bowel mesenteric gas image and abscess formation. Consequently, emergency operation was performed with the diagnosis of perforation of the small intestine. Furthermore, the cecum was found to be in the right upper quadrant of abdomen, for that we acknowledged the presence of intestinal malrotation before surgery. Intraoperative findings included that a small intestine which appeared to be the perforated site had formed a mass and, in the proximal bowel, there were a small intestine associating with white sclerosed stricture and twisting, and multiple diverticula. We thus resected a jejunum by 150 cm in length. Histopathological studies revealed several true diverticula, some of which had abscess formation in their peripheries. From these findings, we diagnosed the case as panperitonitis due to perforation of the jejunal diverticula. Small bowel diverticulosis is a rare entity. Among of them, true diverticula infrequently occur but carry a high mortality. When we encounter a case of peritonitis in which we have great difficulties in diagnosing before surgery, it is important to consider the entity in a differential diagnosis.