Diagnosis of a Perforated Small Bowel Diverticulum in an Elderly Patient Hindered by a Nuck Cyst: A Case Report

Small intestinal diverticulosis is a rare condition, often asymptomatic until complicated with diverticulitis, bleeding, obstruction, or perforation. It predominantly affects elderly men and may present concomitantly with colon diverticulosis. We report the case of a 94-year-old Hispanic woman brought to the emergency department presenting with an acute abdomen. On physical examination, a tense, tender mass was seen in her left inguinal region, initially suspected as an incarcerated inguinal hernia. An abdominal computed tomography scan showed that this mass corresponded to a Nuck cyst. An encapsulated abscess adjacent to a jejunal segment and pneumoperitoneum were also seen, prompting an emergency surgical intervention. Intraoperative findings included a perforated diverticulum in the distal jejunum, as well as extensive diverticulosis involving the ileum and left colon. Resection and anastomosis were performed. Small bowel diverticulitis remains challenging to diagnose preoperatively, and more so in an elderly patient. This case report highlights the role of imaging in discerning among the differential diagnosis for acute abdomen in the elderly patients. It also demonstrates how rare pathologies, such as the Nuck cyst, could masquerade a different etiology and hinder its diagnosis.