Acute Jejenal Diverticulitis: Case Report of Uncommon Presentation

Jejunal diverticulitis is a rare condition and often difficult to diagnose. We report a case of 68-year–old man with a history of sigmoid diverticulitis who presented to the emergency room with a one day history of acute abdominal pain of the left lower quadrant. Initial CT of the Abdomen and Pelvis revealed ileus vs early/partial small bowel obstruction mildly distended loops of the small bowel with decompressed loops of small bowel in the right lower quadrant with no distinct transition point. The patient was treated with antibiotics for presumed gastroenteritis. However, given persistent symptoms and unclear etiology a CT enterography was ordered and demonstrated jejunal diverticulitis with microperforation and a significant phlegmon surrounding the inflamed diverticulum. The patient was treated with ciprofloxacin and metronidazole and reported complete resolution of symptoms after the course of antibiotics. Jejunal diverticula are extremely rare with an incidence of 0.06% to 1.3%. Prior case reports described some of its complications including bleeding, perforation and ulceration. Jejunal diverticulitis should be in the differential diagnosis of acute abdomen especially in patients with unclear etiology. This condition can be missed by contrasted CT of the abdomen and dedicated small bowel imaging such as CT Enterography can assist making the diagnosis.