Jejunal diverticulitis: three case reports of a rare but clinically significant disease

Acquired jejunal diverticulosis is a rare disorder with an unclear pathophysiology that is potentially related to abnormalities in the smooth muscle layer, the myenteric plexus or peristaltic defects and increased intraluminal pressures leading to herniation. Typically occurring in patients older than 60 years of age, jejunal diverticulosis can present without any symptoms, as chronic, nonspecific gastrointestinal complaints, or have an acute onset with high mortality rates for complications such as ileus, fistula, or hemorrhage with the most common being diverticulitis. Of those with jejunal diverticulitis, the most common complications are perforations, bleeding, and bowel obstruction. We presented three cases of complicated jejunal diverticular disease. The first patient presented with unrelenting abdominal pain refractory to analgesia, nausea, fever and associated tachycardia with a localized perforated diverticulum. Patients two and three had a history of pneumatosis intestinalis on CT scan and jejunal diverticulectomy limited to the actively inflamed and microperforated diverticula, three years prior and four months prior, respectively. Patient two was found to have twenty large new jejunal diverticula, two of which had micro perforations. Patient three had extensive diverticulosis, mesenteric abscesses and serositis had an extended ICU stay with intraabdominal infection and fascial dehiscence. Complete segmental resection was performed as a definitive procedure for all three cases, eventually leading to favorable outcomes. Due to the rarity, varied presentation, and high mortality rates, jejunal diverticulosis should always be considered in the diagnostic differential for nonspecific gastrointestinal complaints.