Medical University of South Carolina Charleston, SC, United States
William C. Dungan, MD, John Romano, MD, Puja Elias, MD Medical University of South Carolina, Charleston, SC
Introduction: Small intestinal diverticulosis is a rare gastrointestinal disease, usually presenting as an asymptomatic, incidental finding. The reported incidence is 0.5 - 2.3% on imaging and 7% on autopsy. The etiology of jejunoileal diverticula is not well understood but thought to be secondary to dysmotility and wall weakness. These diverticula may go unrecognized, as a significant portion of the small bowel is not evaluated with routine endoscopy. Therefore, small bowel diverticula and subsequent diverticulitis, although rare, may be more prevalent than stated in the current literature.
Case Description/Methods: A 64-year-old Caucasian female with epilepsy and osteoporosis presented with a 10-day history of worsening, intermittent epigastric pain, distention and constipation. Pain was non-radiating and cramping. She endorsed fever, chills and anorexia. She denied recent illness, weight loss, dysphagia, vomiting, change in stool caliber, melena or hematochezia. She had no past GI medical or surgical history. Family history included ulcerative colitis in her mother. On admission, she was afebrile and hemodynamically stable. Physical exam revealed generalized abdominal tenderness with mild distention. Notable labs included WBC 11.4K/CUMM, normal LFTs, lipase 10 [ULN 81]. CT with contrast revealed duodenal diverticula, jejunal diverticulitis and mesenteric lymphadenopathy with luminal patency. After three days of IV Zosyn and laxatives, she was transitioned to Augmentin x14 days. A capsule endoscopy was undertaken with plans to follow up in GI clinic; however, images of the diverticula were not captured. A CT scan one month later, displayed resolution of diverticulitis.
Discussion: Jejunal diverticulitis can mimic more common GI diseases resulting in improper medical treatment, delayed diagnosis and risk of progression to complicated disease. Physicians should consider this disease when treating those with chronic or recurrent abdominal pain with non-specific lab findings and imaging. Due to the rare nature of jejunal diverticulitis, there is a paucity of guidelines regarding management and follow up. Assessing for malignancy after resolution of acute diverticulitis by methods including pill cam endoscopy, balloon enteroscopy and abdominal imaging is essential. In conclusion, jejunal diverticulitis is a complication of a rare disease warranting additional research regarding prevention, early diagnosis and appropriate follow-up to improve patient outcomes.
Figure: Figure 1: Abdominal imaging in a patient with jejunal diverticulitis. (A) Abdominal Xray AP revealing stool burden in the right colon, without evidence of obstruction or diverticulitis. (B) CT abdomen pelvis with contrast revealing duodenal diverticula, jejunal diverticulitis with wall thickening and mesenteric edema. (C) CT abdomen pelvis with contrast revealing jejunal diverticula with resolution of diverticulitis.
William Dungan indicated no relevant financial relationships.
John Romano indicated no relevant financial relationships.
Puja Elias indicated no relevant financial relationships.
William C. Dungan, MD, John Romano, MD, Puja Elias, MD. P0941 - Tics in the Small Intestine: An Unusual Case of Jejunal Diverticulitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.