Perforated jejunal diverticulitis in a nonagenarian veteran: A case report

INTRODUCTION: Jejunal diverticular (JD) disease is an uncommon occurrence that frequently present as a diagnostic dilemma. The correct diagnosis from complications of JD is typically made at laparotomy. Most JD are asymptomatic. Of clinically significant small bowel diverticula, only 15% present with surgical problems including obstruction, gastrointestinal bleed, and perforation. PRESENTATION OF CASE: A 90-year-old man presented to the hospital with abdominal pain. He was clinically stable with local tenderness in the left lower quadrant. Computed tomography demonstrated a dot of free air near the sigmoid and sigmoid diverticula. He continued to have pain and clinically deteriorated following a short period of observation. He underwent an exploratory laparotomy that revealed perforated JD. CONCLUSION: Perforation from JD is exceedingly rare. Due to their infrequent clinical significance, complications from JD are difficult to diagnose and therapeutic options are typically made intraoperatively. Any deviation from the expected positive pathway in the management of a suspected entity should prompt an immediate reassessment as well as definitive therapeutic options.