Laparoscopic approach of jejunal diverticulitis: a rare, but important differential in the acute abdomen

Cases of small bowel diverticulitis, excluding Meckel's diverticulitis, are rare. Prevalence increases with age, characteristically in males in the sixth to eighth decades of life and it can have complications such as diverticulitis, acute intestinal obstruction, diverticular bleeding and mainly perforation with mesenteric abscess, localized or generalized peritonitis. These uncommon complications can be result in major surgery and high overall mortality. Here we present a case of a 58-year-old patient coming to the emergency department with abdominal pain, fever and one episode of vomiting. The CT scan displayed one inflammatory mass and a fair amount of free liquid in the abdomen. The radiologist was unable to provide a certain diagnosis: it could have been a diverticulum, an intestinal duplication, or an abscess. The patient had to underwent immediate surgery with laparoscopic approach that revealed purulent liquid and two inflamed jejunal diverticulum. A laparoscopic lavage was made, then we decided to convert the procedure to mini laparotomy: the incision was directed nearer to the area of the disease thanks to the previous diagnosis performed with laparoscopic method. A small bowel resection with primary anastomosis was performed. The patient had an unremarkable recovery with no complications for the remainder of his admission. Jejunal diverticulum is rare but may cause serious complica-tions. Its prevalence in older populations and variable presentation warrants a high degree of suspicion for any abdominal complaint without an appropriate alternate diagnosis. CT is not always adequate to distinguish the entities or narrow the differential diagnosis. In addition to fa-cilitating a correct diagnosis, laparoscopic exploration and washout may provide effective management of the acute attack, reducing the size of laparotomy incision. We advocate that diagnostic laparoscopy should be considered in cases of suspected acute jejunal diverticulitis, when the CT scan failed to diagnose properly.