Acute abdomen caused by a large solitary jejunal diverticulum that induced a midgut volvulus. Report of a case. (2020)

• Record Type: Journal Article
• Authors: Nigam, Aradhya; Gao, Faye F.; Steves, Mark A.; Sugarbaker, Paul H.
• Is Part Of: International journal of surgery case reports. Volume 74(2020)
• Page Start: 109
• Page End: 112
• Publication Date: 2020
• Subjects: Pulsion diverticulum -- Acute abdomen -- Midgut volvulus -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2020.07.082
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Diverticuli are found throughout the gastrointestinal tract from esophagus to rectum. In the jejunum diverticuli are most commonly proximal, multiple and asymptomatic. A large solitary jejunal diverticulum caused life endangering midgut volvulus. In the absence of timely surgical intervention the condition would have been fatal. Abstract: Background: Jejunal diverticula are a rare subtype of false diverticula found in the gastrointestinal tract. When present, they are usually multiple, in the proximal jejunum and asymptomatic. Rarely, they can cause acute complications that can develop into an acute abdomen requiring surgical intervention. We present the rare manifestation of a single jejunal diverticulum causing midgut volvulus and bowel ischemia. Early surgical intervention with small bowel derotation allowed complete recovery. Methods: Data regarding the case, operative intervention, and patient follow-up was prospectively accumulated with permission of the patient at an academic institution. All patient identifiers were removed. All research steps were performed under guidance outlined in the SCARE criteria. Results: We present the case of a 78-year-old man who presented to our institution with an acute abdomen. CT imaging demonstrated a whirlpool sign without an obvious lead point. The patient was without prior surgical intervention. Urgent exploratory laparotomy revealed a midgut volvulus with associated bowel ischemia and impending infarction secondary to adhesive disease from a large single jejunal diverticulum. Derotation resulted in gradual recovery of bowel vascularity. Resection of the portion of the jejunum containing the diverticulum resulted in full clinical recovery of the patient. Conclusions: Complications of jejunal diverticula, although rare, should be considered as part of the differential diagnosis of an acute abdomen of unknown etiology. Urgent surgical intervention was required to avoid a potential catastrophic outcome.