Title:Perforated Jejunal Diverticulum. Laparoscopic Management

Aims: Jejunal diverticular disease is a rare but important clinical entity. The perforation of a jejunal diverticulum is infrequent and the treatment has been classically exploratory laparotomy, with resection of the affected intestinal segment. However, the laparoscopic approach can be a good alternative in these cases, providing the known advantages of this type of surgery.

 Methods: We present the case of a 75-year-old man with a history of colonic diverticulosis with two episodes of acute diverticulitis admitted for the study of rectal bleeding. On the third day of admission, he presented with a sudden onset of abdominal pain accompanied by a vasovagal condition, with defense and generalized peritoneal irritation. The CT scan showed pneumoperitoneum in a moderate amount and a discrete amount of free fluid, as well as the presence of diverticula throughout the colon and a large jejunal diverticulum.

Results: Urgent surgical intervention was decided, performing a laparoscopic approach with both diagnostic and therapeutic purposes. A total of four trocars were used, with a moderate amount of purulent peritoneal exudate in the left subphrenic space, perisplenic, between the loops and in the pelvic area. Also, a small perforation was revealed at the antimesenteric border of a large jejunal diverticulum, about 25 cm from the Treitz angle. After the dissection and release of the diverticulum, it was resected at the base level with endostapler. The postoperative period was uneventful and was discharged on the 6th postoperative day

Conclusions: The laparoscopic approach of perforated jejunal diverticula is an option that, if it has the technical and human resources to carry it out, can be a great advantage for the treatment of this surgical complication.

Keywords: Jejunal diverticulum; Surgery

Presented at

25th International Congress of the European Association for Endoscopic Surgery. Frankfurt 14-17 June 2017