Perforated Jejunal Pseudoiverticulum in a Child

Prime Hospital has been handling rare medical cases with high success rates. One of the challenging cases recently treated by its team of specialists involved a six-year-old boy who was diagnosed with the usually asymptomatic jejunal diverticulosis. The incidence of jejuna diverticulosis in children is very rare, making his case worthy of careful and thorough examination to better understand this disease affecting both children and adults.     

Here in the case of the young patient, he was rushed to the emergency room due to abdominal pain, vomiting, and diarrhea. The attending physician ordered abdominal computed tomography (CT) scan to determine the cause. Results showed fluid and distended small bowel loops seen with features suggestive of subacute small bowel obstruction. His doctor decided to perform diagnostic laparoscopy, which revealed perforated jejunal diverticulum.

An emergency laparotomy was done during which jejunal diverticulum with perforation was seen with pus and adhesions. Resection of small segment of bowel with perforated diverticulum and anastomosis was performed as well in the patient. Histopathology revealed features of pseudo diverticulum with perforation. Four months post-surgery, the child was doing well.

Indeed, this is a challenging disorder from a diagnostic perspective. Abdominal imaging may show features of perforation such as free air under the diaphragm or evidence of obstruction in the form of multiple air fluid levels and bowel dilation.

Endoscopic procedures are useful but it cannot be used in an emergency setting. As such, in the event of obstruction or perforation, diagnostic laparoscopy is a useful tool. If laparoscopic findings show perforation, abscesses, and mechanical obstruction and the like, exploratory laparotomy is required, while resection of the affected bowel and primary anastomosis is recommended.

Hence, considering this condition in the differential diagnosis of acute abdominal emergencies in adults and children with features of intestinal obstruction both clinically and on imaging, specialists should promptly manage the condition to prevent serious complications such as perforation.

Jejunal diverticula are rare and majority of them are asymptomatic. Nonetheless, it is considered an acute abdominal emergency, hence, the condition should be considered in the differential diagnosis and management of small bowel diverticular disease and could necessitate surgical repair to successfully treat the disease similar to the case of the six-year-old patient


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