Jejunal diverticula presenting with small bowel volvulus and perforations: A rare life threatening complication

ABSTRACT: Jejunal diverticula are uncommon and may lead to complications like inflammation, perforation, and peritonitis. Small bowel volvulus (SBV), characterized by the twisting of the small intestine around its mesentery, can result in obstruction and strangulation. The coexistence of jejunal diverticula with SBV is a rare and potentially fatal condition. Case Presentation: A 60-year-old male presented with a four-day history of abdominal pain, distension, and non-passage of feces and flatus. He had a history of chronic smoking and alcohol use but no significant past medical or surgical history. Imaging studies indicated jejunal volvulus with dilated bowel loops, without signs of ischemia. Exploratory laparotomy revealed SBV with multiple jejunal diverticula located 25 cm, 35 cm, and 100 cm distal to the ligament of Treitz, with perforations in the latter two. Ischemia was noted in the terminal ileum and ileocecal junction. Surgical intervention included segmental jejunal resection with primary anastomosis and limited right hemicolectomy with end ileostomy and distal mucus fistula. The patient succumbed to sepsis on the fifteenth postoperative day. Conclusion: Jejunal diverticula complicated by SBV and perforation represent a rare, life-threatening scenario. Prompt diagnosis and urgent surgical management are essential for improving patient outcomes. Keywords: Jejunal diverticula, small bowel volvulus, perforation, peritonitis, sepsis