A Case of Acute Peritonitis Induced by a Perforated Jejunal Diverticulum

Masaru Koizumi, Naohiro Sata, Toru Hamada and Yoshikazu Yasuda

Department of Surgery, Jichi Medical University

A 96-year-old woman with 3 days of abdominal pain and constipation and admitted for further examination. She had no history of peptic ulcer disease or nonsteroidal antiinflammatory drug use. Physical examination showed abdominal tenderness, muscular rigidity, and rebound tenderness in the upper abdomen. Abdominal computed tomography showed ascites and free air, suggesting acute peritonitis caused by upper gastrointestinal (GI) tract perforation. Laboratory data showed a white blood cell count of 10,500 and CRP of 20.4 mg/dl. Exploratory laparotomy showed mesenteric perforation of the jejunal diverticulum 30 cm distal to the ligament of Treitz, necessitating segmental resection of the jejunum, performed. Pathologically, the result was pseudo-diverticulum perforation. Although the patient suffered acute myocardial infarction on postoperative day (POD) 4, she was discharged on POD18. In cases of the upper GI tract, perforation of a jejunal diverticulum should be suspected and emergency laparotomy considered.

Key words
jejunal diverticulum, perforation, peritonitis

Reprint requests
Masaru Koizumi Department of Surgery, Jichi Medical University
3311-1 Yakushiji, Shimotsuke, 329-0498 JAPAN

Accepted
January 28, 2009

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