S6179 A Case Series on Presentation and Management of Jejunal Diverticulitis

Introduction: Jejunoileal diverticulitis is a relatively rare condition compared to its colonic equivalent with a prevalence of 0.07%-2.0%. Here we share 3 distinct patients with jejunal diverticulosis who presented with diverticulitis. All 3 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 prior medical history of hypertension, hyperlipidemia, hypothyroidism, and gout who presented hemodynamically stable (HDS) with acute lower abdominal pain. Computed tomography 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. Intravenous piperacillin/tazobactam started while inpatient. She was discharged after a good post-operative recovery period. A 62-year-old woman with prior medical history of gastroesophageal reflux disease, chronic gastritis, grade B esophagitis, and hiatal hernia status post fundoplication who presented HDS with periumbilical pain. Computed tomography revealed jejunal diverticulitis with stranding of the abdominal mesentery. Gastroenterology was consulted for acute uncomplicated jejunal diverticulitis. There was clinical improvement on intravenous piperacillin/tazobactam. She was transitioned to by mouth antibiotics and discharged for magnetic resonance enterography outpatient. An 82-year-old man with prior medical history of hypertension, diabetes mellitus, tobacco use, and metastatic lung cancer status post 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. Computed tomography showed jejunal diverticulosis with wall thickening and pneumoperitoneum representing perforation. Intravenous 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.