John Nahas, MD1, Sinay Ceballos, MD2, Franklin Kasmin, MD2 1HCA Healthcare, Aventura, FL; 2Aventura Hospital, Aventura, FL Introduction: Jejunoileal diverticulitis is a relatively rare condition compared to its colonic equivalent with a prevalence of 0.07-2.0%. Here we share three distinct patients with jejunal diverticulosis who presented with diverticulitis. All three clinical vignettes end with vastly differing outcomes, which further adds the clinical utility of this contribution to the literature.
Case Description/
Methods: An 88 year old woman with PMH of HTN, HLD, hypothyroidism, and gout who presented hemodynamically stable (HDS) with acute lower abdominal pain. CT showed inflamed segments of small bowel, jejunal thickening, and bowel wall pneumatosis. Both general surgery (GS) and gastroenterology (GI) were consulted. A robotic converted open enterectomy with side to side anastomosis was performed for perforated jejunal diverticula. IV Piperacillin/Tazobactam started while inpatient. She was discharged after a good post-operative recovery period.
A 62 year old woman with PMH of GERD, chronic gastritis, grade B esophagitis, and hiatal hernia s/p fundoplication who presented HDS with periumbilical pain. CT revealed jejunal diverticulitis with stranding of the abdominal mesentery. GI was consulted for acute uncomplicated jejunal diverticulitis. There was clinical improvement on IV Piperacillin/Tazobactam. She was transitioned to PO antibiotics and discharged for MR enterography outpatient.
An 82 year old man with PMH of HTN, DM, tobacco use, and metastatic lung cancer s/p chemo and radiation who presented with sudden onset abdominal pain. He was unstable with HR = 120s, BP = 50s/30s and SpO2 = 85% requiring pressors and intubation. CT showed jejunal diverticulosis with wall thickening and pneumoperitoneum representing perforation. IV Piperacillin/Tazobactam was started. GS performed emergent ex-lap with small bowel resection, omentectomy, and open wound VAC for perforated jejunal diverticulosis and carcinomatosis. Given the extent of his metastatic disease, palliative medicine was consulted for a palliative extubation. Discussion: Several key clinical pearls can be appreciated in this study. First, there is an increase in morbidity and mortality in the case of serious complications such as perforation. We also consider the role that age and comorbities play in clinical outcomes. Finally, diverticular pockets which are not accessible via endoscopy present unique screening challenges. Jejunoileal diverticulitis represents the vast minority of reported cases and thus further study is imperative to better shape management.
Disclosures: John Nahas indicated no relevant financial relationships. Sinay Ceballos indicated no relevant financial relationships. Franklin Kasmin indicated no relevant financial relationships.
John Nahas, MD1, Sinay Ceballos, MD2, Franklin Kasmin, MD2. P6237 - A Case Series on Presentation and Management of Jejunal Diverticulitis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
