A Case of Jejunal Diverticulum Perforation Suspected to Be Caused by a Foreign Body

• Published in: Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 39; no. 7; pp. 1221 - 1225
• Main Authors: Shiraishi, Toshio, Arai, Junichi, To, Kazuo, Inamura, Yukio, Iwasaki, Keisuke, Takamura, Yuma, Ishikawa, Hiroshi, Tanoue, Yukinori
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society for Abdominal Emergency Medicine 30.11.2019; 日本腹部救急医学会
• Subjects: 小腸憩室穿孔; 異物; 空腸憩室穿孔
• ISSN: 1340-2242; 1882-4781
• DOI: 10.11231/jaem.39.1221

Rupture of a jejunal diverticulum is rare, and it is often difficult to diagnose preoperatively. A 68-year-old American man was admitted to our hospital complaining of epigastric pain. Blood examination showed evidence of severe inflammation. Physical examination revealed rebound tenderness in the upper abdomen, and equivocal muscle guarding. Abdominal computed tomography showed a 30-mm tumor-like lesion containing air in the middle of the lower abdomen with inflammatory change around it. This lesion was suspected to be connected to the small intestine. Because of the possibility of a perforated jejunal gastrointestinal stromal tumor (GIST), emergency surgery was performed. When an adhesion of the mesojejunum was peeled off, purulent discharge escaped. A perforated jejunal diverticulum was observed on the mesenteric side of the jejunum about 75 cm from the ligament of Treitz. Partial resection of an approximately 20-cm segment of the jejunum was performed. Three cellophane-like foreign bodies were identified in the perforated diverticulum in the resected specimen, and it was suspected that the foreign bodies could have caused the diverticular perforation. A case of jejunal diverticulum perforation suspected to be caused by a foreign body is described. This case reaffirms the importance of preoperative imaging.