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AbstractsL ACCEPTED: CLINICAL VIGNETTES/CASE REPORTS - SMALL INTESTINE/UNCLASSIFIED

A Case Series of Jejunal Diverticulosis: A Variety of Presentations

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Patel, Boskey DO1; Basil, Anjali M.D2; Cave, David R. MD, PhD FACG3

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American Journal of Gastroenterology: October 2016 - Volume 111 - Issue - p S1047
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Jejunal diverticulosis (JD) is a rare entity that manifests in various ways, from a lack of symptoms to potentially fatal complications like bowel perforation or gastrointestinal hemorrhage. We describe four patients with this condition.

Case 1: A 53-year-old female presented to the ED with crampy abdominal pain. Abdominal CT scan revealed small bowel thickening and air-fluid level consistent with perforated diverticulitis. The patient improved with antibiotics. She subsequently underwent an outpatient CT enterography (CTE), which showed resolution of the diverticulitis but persistence of two jejunal diverticula without symptomology.

Case 2: A 27-year-old male presented to the emergency department with diffuse abdominal pain. A CT abdomen showed small bowel obstruction, diverticulitis, perforations, and colonic diverticula. A laparotomy was performed, with partial resection of the jejunum containing the diverticula and area of perforation (Figure 1). He was treated with antibiotics and discharged. A repeat CT one year later was normal, as were colonoscopy, esophagogastroduodenoscopy (EGD), and CTE. A video capsule endoscopy (VCE) showed recurrent jejunal diverticula without diverticulitis.

Figure 1
Figure 1

Case 3: A 62-year-old male on warfarin presented to the emergency department with melena and hematochezia. Neither EGD nor colonoscopy showed an active bleed. One month after discharge, he underwent outpatient VCE, which suggested jejunitis, and a double-balloon enteroscopy, which showed multiple jejunal diverticula. An abdominal CT scan was obtained, with findings consistent with diverticulitis. The patient was treated with antibiotics and underwent elective laparoscopic small bowel resection.

Case 4: A 64-year-old male went to his primary care physician for worsening gastroesophageal reflux. He was sent for an EGD, from which he received a biopsy-proven diagnosis of duodenal neuroendocrine tumor. Several jejunal diverticula were incidentally noted on small bowel enteroscopy and laparoscopy. This area was resected and a primary anastomosis was performed. While the patient did have recurrence of the duodenal tumor and jejunal diverticula, he had no signs or symptoms of complications related to diverticular disease post-resection. JD is an uncommon condition with a spectrum of presentations. Early diagnosis and proper management is important to prevent morbidity. Diagnostic modalities that are helpful include abdominal CT or MRI, capsule endoscopy, and deep enteroscopy.

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