Mesenteric Perforation due to Jejunal Diverticulitis in a Patient on Dialysis after Surgery for Hereditary Polycystic Kidney—A Case Report—

Abstract

A 70-year-old man with a history of hereditary polycystic kidney disease underwent bilateral nephrectomy for management of infection and was then on hemodialysis since the operation. He presented with abdominal pain, and blood test results showed an increased inflammatory response. Abdominal contrast-enhanced computed tomography showed a suspected small intestinal perforation, and emergency laparotomy was performed. Intraoperative findings showed multiple jejunal diverticula predominantly near the ligament of Treitz. Partial jejunectomy including the perforated area was performed. Histopathologically, the patient was diagnosed with perforation of a pseudodiverticulum of the small intestine. Perforation of jejunal diverticula is relatively rare, and preoperative diagnosis is often challenging due to the formation of intestinal intramural abscesses and the absence of signs of peritoneal irritation. This condition may result in serious complications in patients in poor physical condition and should be considered in the differential diagnosis in patients with fever and abdominal pain without evidence of peritoneal irritation. In this report, a case of mesenteric perforation secondary to jejunal diverticulitis in a patient on hemodialysis is described.