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Non-surgical management of recurrent perforation of a jejunal diverticulum following previous segmental bowel resection: a case report

DOI: 10.4076/1752-1947-3-7318

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Abstract:

We report a recurrent perforation of a jejunal diverticulum in an 87-year-old Caucasian man who presented with a 1-week history of epigastric pain. The diagnosis of a perforated jejunal diverticulum was made from the appearances of the abdominal computed tomography scan together with the presence of jejunal diverticula noted at the time of a previous laparotomy for the first perforation of a jejunal diverticulum.Whilst this case report by itself does not add to the knowledge we already have of jejunal diverticula, it is one report of a rare condition and more reports are required in the future to establish the recurrence rate of jejunal diverticula perforation and how perforated jejunal diverticula are best managed.This is a rare case of repeated perforations of jejunal diverticula. To the best of our knowledge, there are only two previous similar reports [1,2]. This is however the first reported case of a recurrent perforation being treated successfully non-operatively.Jejunal diverticula are uncommon, with reported incidences at autopsy of 0.26% to 1.3%, occurring mostly after the sixth decade of life and slightly more often in men than in women. Jejunal diverticula occur on the mesenteric side of the bowel wall, which is weakened by the penetration of blood vessels [3]. They are thought to be acquired pulsion diverticula, arising as a result of motor dysfunction of the smooth muscle or the myenteric plexus in the small bowel [4,5]. The diverticula are usually distributed in the proximal jejunum [6], but they can be present anywhere along the small bowel and can be extensive in their distribution [7].A significant proportion of people with jejunal diverticula have chronic symptoms including abdominal pain after food associated with nausea, vomiting, belching, flatulence, diarrhoea, or constipation [8]. Serious and acute complications arise less frequently and include gastrointestinal haemorrhage, perforation and intestinal obstruction, occurring in 6% to 10% of pa

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