A Case of Multiple Jejunal Diverticula Performed Partial Jejunal Resection for Mesenteric Penetration

Abstract

A 68-year-old man presented with upper abdominal pain. Spontaneous pain and localized tenderness were observed in the left upper quadrant of abdomen, but there were no signs of peritoneal irritation. Abdominal computed tomography showed multiple diverticula on the mesenteric side of the proximal jejunum and extraintestinal gas in the nearby mesentery. The diagnosis of mesenteric penetration in the jejunal diverticulum was made. Since the abdominal symptoms were slight and the imaging findings were localized, conservative treatment with fasting and administration of antibacterial drugs was selected. A re-examination of the abdomen on the 3rd hospital day revealed exacerbation of mesenteric inflammation and extraintestinal gas, therefore emergency operation was performed on the 4th hospital day. Multiple diverticula were found in the jejunum ranging 60 cm from the vicinity of the Treitz ligament, and, in the jejunal mesentery from 30 cm to 50 cm, inflammatory findings were observed. A partial jejunal resection including the penetration was performed. The patient was discharged 9 days after the operation. Penetration or perforation of the jejunal diverticulum is a rare disease. It has few physical symptoms and may become severe while we are struggling to make the diagnosis. This disease should be kept in mind as a differential diagnosis of acute abdomen by grasping its characteristic imaging findings.