A Case of Jejunal Diverticulum Perforation One Month after Surgery for Strangulated Bowel Obstruction

Abstract

A small bowel diverticulum is a rare condition, and there have been few reports of diverticular perforation. The case of a patient in whom a jejunal diverticulum that had been identified during surgery for strangulated bowel obstruction rapidly became perforated due to adhesive bowel obstruction in the early postoperative period is described. An 81-year-old man was referred to our hospital with strangulated bowel obstruction and underwent emergency surgery the same day. During the operation, it was found that the root of the small bowel mesentery was strangulated by an internal hernia, and the entire small intestine was ischemic. Multiple diverticula were also identified in the ischemic small bowel. Only the strangulation was released, and the patient was discharged improved on postadmission Day 17. On Day 38, the patient developed adhesive bowel obstruction, and since this did not respond to conservative therapy, surgery to release the adhesions was performed on Day 44. One of the small bowel diverticula that had been identified during the initial surgery had perforated, and an intra-abdominal abscess was present. A small portion of the jejunum that included the perforation site was resected, and the patient was discharged on Day 59. Pathological examination showed that this was a pseudodiverticulum. The jejunal pseudodiverticulum may have been weakened by ischemia and perforated due to the elevated intestinal pressure caused by the adhesive bowel obstruction.