Back to 2025 Posters
PERFORATED DUODENAL-JEJUNAL FLEXURE DIVERTICULITIS: A CASE REPORT
Ricardo A. Beltran Mejia
*1,2, Fernando Quijano Orvañanos
1, Diego Angulo Molina
1, Disemina Lanzagorta Ortega
1, Alba Mayra Padilla Correa
11Cirugia General, Asociacion Medica del Centro Medico ABC, Mexico City, Mexico City, Mexico; 2American College of Surgeons, Mexico City, Mexico City, Mexico
INTRODUCTIONDuodenal-jejunal flexure diverticulitis is a rare condition characterized by inflammation and potential perforation of diverticula at the duodenojejunal junction. While more commonly associated with the colon, diverticula in this location are rare and often under-recognized [1]. This report describes a 76-year-old male with gastrointestinal symptoms who developed complications, including perforation and abscess formation, highlighting the importance of early recognition and timely management [3, 4]
CASEA 76-year-old male with obesity and tobacco use presented with abdominal pain and distension. CT imaging revealed sac-like diverticula with hypodense material and gas (18 mm and 22 mm), inflammatory changes, and loss of wall continuity, suggesting perforated jejunal and duodenal diverticulitis. Laboratory results showed leukocytosis and elevated CRP. Treatment with cefixime and metronidazole improved symptoms and acute phase reactants
One month later, the patient returned with colicky abdominal pain, tenderness, and elevated CRP (18.05) and PCT (2.38). CT imaging showed a complicated jejunal diverticulum with abscess (2.6 x 2.3 cm), fat stranding, and free fluid. Exploratory laparotomy revealed purulent fluid and an 8 mm perforation in a duodenal diverticulum. A resection of proximal jejunum and duodenojejunal side-to-side anastomosis was performed. Postoperative care included antibiotics and thromboprophylaxis. Oral intake resumed on day 6 after confirming no anastomotic leak. The patient was discharged on day 13, asymptomatic
DISCUSSIONJejunal diverticulitis (JD) is rare, with a prevalence of 1–4.6% [5]. Many cases are asymptomatic, but complications like perforation (2.1) or obstruction (2.3) may arise [5, 7]. This case shows how JD can progress from conservative management to surgical intervention.
Diverticula at the duodenojejunal flexure pose surgical challenges due to the proximity of vital structures. In this case, inflammation and friable tissue necessitated resection of proximal jejunum and reconstruction via a tension-free duodenojejunal anastomosis. Retrocolic routing reduced tension and optimized alignment, ensuring better outcomes. Early recognition and individualized strategies were crucial to managing complications effectively.
Conservative management may suffice initially, but failure occurs in 20–30% of cases [6, 8]. Resection is the definitive approach in severe cases, while alternatives like diverticular inversion with omental patching may be considered in selected scenarios.
CONCLUSIONJD management requires a tailored approach based on clinical presentation and anatomy. This case highlights successful surgical management with duodenojejunal anastomosis and emphasizes the importance of high suspicion in elderly patients with atypical abdominal symptoms. Further studies are needed to refine algorithms for this rare condition.
Figure 2:
Duodenojejunal flexure diverticulum on the mesenteric side with an 8 mm perforation.
Back to 2025 Posters
