S6216 Acute Jejunal Diverticulitis Complicated by Abscess: A Diagnostic and Management Challenge

Introduction: Jejunal diverticulosis, a rare condition involving diverticula in the jejunum, is often found incidentally or when complicated by diverticulitis. While more common in the colon, jejunal diverticulosis poses diagnostic challenges due to its rarity and nonspecific symptoms. Imaging, particularly computed tomography, is crucial for diagnosing jejunal diverticulitis and guiding management. Case Description/Methods: A 70-year-old man with history of hypertension developed acute left lower abdominal pain while on vacationing in Jamaica. The patient opted to return to the United States for care, where computed tomography with intravenous contrast confirmed multiple small jejunal diverticula and a 4.5 × 4.1 cm circular mass with fluid and debris. The mass communicated with the bowel, suggesting diverticulitis or, less likely, a contained perforation with abscess. Follow-up computed tomography with oral contrast showed a 5 cm × 5 cm rim-enhancing structure near the jejunum containing succus, oral contrast, and air, with surrounding fat induration and adjacent small lymph nodes. These findings were consistent with jejunal diverticulitis complicated by an abscess. No free air or obstruction was present. The patient underwent robotic-assisted laparoscopic surgery, including lysis of adhesions, partial enterectomy with primary anastomosis, and partial omentectomy. He received an intravenous antibiotic course, clinically improved, and was discharged after recovery. Discussion: Jejunal diverticulosis, while uncommon, can range from asymptomatic to presenting with acute abdominal pain, nausea, vomiting, and gastrointestinal bleeding. Complications such as diverticulitis, perforation, or abscess formation can occur, requiring prompt diagnosis and intervention. Computed tomography imaging plays a pivotal role in diagnosing jejunal diverticulitis by revealing diverticula, associated inflammatory changes, and potential for abscess formation. In this case, computed tomography with oral and intravenous contrast was essential in differentiating jejunal diverticulitis from other abdominal pathologies, such as small bowel perforation or mesenteric ischemia. Jejunal diverticulitis is typically managed conservatively with antibiotics in uncomplicated cases. However, surgical intervention is required when abscess or perforation is present. Surgical options include bowel resection, primary anastomosis, and abscess drainage, depending on the severity. Our patient's successful recovery following robotic-assisted laparoscopic surgery highlights the effectiveness of minimally invasive techniques in managing complicated jejunal diverticulitis.