Jejunal diverticulitis: An unusual cause of left lower quadrant abdominal pain in a young female

Chandrashekhar A Sohoni

doi:10.4103/0975-9727.135766

Users Online:Login

CASE REPORT

Year : 2014 | Volume : 5 | Issue : 2 | Page : 177-178

Jejunal diverticulitis: An unusual cause of left lower quadrant abdominal pain in a young female

Chandrashekhar A Sohoni
Department of Radiology, NM Medical, Pune, Maharashtra, India

Date of Web Publication

1-Jul-2014

Correspondence Address:
Chandrashekhar A Sohoni
B-5, Common Wealth Hsg. Soc., Opp. Bund Garden, Pune - 411 001, Maharashtra
India

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/0975-9727.135766

Abstract

Acquired small bowel diverticulitis is an uncommon condition, predominantly affecting elderly population. It is exceedingly rare in young adults. Such a rare case of jejunal diverticulitis in a young female is presented here. Due to the nonspecific clinical presentation, accurate clinical diagnosis of this condition is difficult. Computed tomography (CT) scan provides early and specific diagnosis, thus facilitating successful nonsurgical treatment.

Keywords: Computed tomography, left lower quadrant abdominal pain, small bowel diverticulitis, young adult

How to cite this article:
Sohoni CA. Jejunal diverticulitis: An unusual cause of left lower quadrant abdominal pain in a young female. Muller J Med Sci Res 2014;5:177-8

How to cite this URL:
Sohoni CA. Jejunal diverticulitis: An unusual cause of left lower quadrant abdominal pain in a young female. Muller J Med Sci Res [serial online] 2014 [cited 2023 May 28];5:177-8. Available from: https://www.mjmsr.net/text.asp?2014/5/2/177/135766

Introduction

The usual differential diagnosis of left lower quadrant (LLQ) abdominal pain in a young adult female does not include acquired small bowel diverticulitis. When ultrasound fails to provide a specific diagnosis in a case of persistent LLQ pain, computed tomography (CT) scan should be perfomed to exclude uncommon etiologies.

Case Report

A 27-year-old married female presented with the LLQ abdominal pain for 7 days. There was no history of fever, nausea, vomiting, or diarrhea. The patient had a history of irregular menstruation for the past 3 years for which no treatment was taken. She had a history of constipation for which she had been taking ispaghula on and off for the past few months. She was overweight (95 kg). On examination, her pulse rate was 90 per minute and blood pressure was 140/90 mm Hg. Tenderness could be elicited in LLQ of abdomen; however, there was no guarding or rigidity. Abdominal ultrasound examination revealed grade 2 fatty liver and bilateral polycystic ovaries. CT scan was performed due to persistence of the pain and it showed a jejunal diverticulum measuring 1.5 cm in transverse diameter with mild surrounding mesenteric fat stranding [Figure 1]a and b suggestive of diverticulitis. The total white blood cell (WBC) count was 13,500/cm ³ . Rest of the laboratory parameters were unremarkable. The patient was treated with intravenous levofloxacin and metronidazole during her hospital stay of 5 days, followed by the same antibiotics orally for 2 weeks on discharge. The patient was completely asymptomatic at the time of follow-up 2 weeks later and her total WBC count had normalized.

Figure 1: (a and b) The computed tomography (CT) images reveal a jejunal diverticulum with surrounding mesenteric fat stranding, suggestive of diverticulitis

Click here to view

Discussion

True or congenital intestinal diverticula are composed of all layers of the intestinal wall. Meckel's diverticulum is a true diverticulum that is seen in the distal ileum. False or acquired diverticula, which are the focus of this article, are formed from the herniation of the mucosal and submucosal layers. The commonest site of occurrence of small bowel diverticula is the duodenum, followed by jejunum and ileum. ^[1]

The exact etiology of acquired small bowel diverticulosis is unknown. It is believed to develop as the result of abnormalities in peristalsis, intestinal dyskinesis, and high segmental intraluminal pressures. ^[2] Constipation is commonly associated with large bowel diverticulosis. A study has previously described motor dysfunction of small bowel in a patient with small bowel diverticulitis. ^[3] Thus, constipation, which is the result of impaired bowel motility, may also be associated with small bowel diverticulosis. The diverticula act as foci for bacterial overgrowth which in-turn leads to inflammation of the diverticular wall (diverticulitis).

Cases of jejunoileal diverticulitis have been reported previously after the fifth decade of life, most commonly in elderly people between 60-70 years of age. ^[2],[4],[5] Acquired small bowel diverticulitis below the age of 30 years, as seen in our case, is extremely unusual. Due to nonspecific symptoms, clinical diagnosis of small bowel diverticulitis is difficult. It may present with features of nausea, vomiting abdominal pain, and fever. In our case, the more common differential diagnosis of LLQ pain such as ovarian torsion, ectopic pregnancy, ureteric colic, or epiploic appendagitis were thought of. Since it helps make a specific diagnosis, CT is the noninvasive modality of choice for diagnosis of diverticulitis. ^[6],[7] In the absence of complications, small bowel diverticulitis can be treated nonsurgically using bowel rest, intravenous hydration, and antibiotics. ^[5] Surgical intervention should be reserved for patients with complications such as bleeding, perforation, or obstruction. ^[2],[5],[7] In the case described above, accurate diagnosis with CT enabled us to manage the patient only with antibiotics and supportive care, without the need for surgical exploration.

Conclusion

In conclusion, acquired jejunal diverticulitis which is usually seen in older age-group may very rarely present with acute abdominal pain in young adults. The treating physician and the radiologist need to be aware of this rare possibility, since early diagnosis can enable effective nonsurgical management.

References

1.	Akhrass R, Yaffe MB, Fischer C, Ponsky J, Shuck JM. Small-bowel diverticulosis: Perceptions and reality. J Am Coll Surg 1997;184:383-8.
2.	Ferreira-Aparicio FE, Gutierrez-Vega R, Galvez-Molina Y, Ontiveros-Nevares P, Athie-Gútierrez C, Montalvo-Javé EE. Diverticular disease of the small bowel. Case Rep Gastroenterol 2012;6:668-76.
3.	Kongara KR, Soffer EE. Intestinal motility in small bowel diverticulosis: A case report and review of the literature. J Clin Gastroenterol 2000;30:84-6.
4.	Mantas D, Kykalos S, Patsouras D, Kouraklis G. Small intestine diverticula: Is there anything new? World J Gastrointest Surg 2011;3:49-53.
5.	Veen M, Hornstra BJ, Clemens CH, Stigter H, Vree R. Small bowel diverticulitis as a cause of acute abdomen. Eur J Gastroenterol Hepatol 2009;21:123-5.
6.	Macari M, Faust M, Liang H, Pachter HL. CT of jejunal diverticulitis: Imaging findings, differential diagnosis, and clinical management. Clin Radiol 2007;62:73-7.
7.	Falidas E, Vlachos K, Mathioulakis S, Archontovasilis F, Villias C. Multiple giant diverticula of the jejunum causing intestinal obstruction: Report of a case and review of the literature. World J Emerg Surg 2011;6:8.