Case report: Challenges in diagnosis and treatment of Small bowel diverticulitis presenting with acute abdomen

Small bowel diverticulitis is a rare condition that is often excluded in the differential diagnosis of acute abdomen. We herein present two cases of patients with small bowel diverticulitis who presented with acute abdomen. First case was a 72-year-old lady who presented to emergency with 2 days of sudden-onset worsening generalized abdominal pain. The computed tomography (CT) revealed a segment of abnormally thickened jejunum with marked adjacent inflammatory mesenteric fat stranding and adjacent extraluminal gas locules, in keeping with complicating perforation. The patient was subsequently taken to the operating theater for an emergency laparotomy which revealed a contained perforation of the proximal jejunum secondary to a ruptured diverticulum. 20 cm of proximal jejunum containing the perforation was resected. The patient recovered uneventfully and was discharged day 7 following the operation. Second case was a 78-year-old lady who presented with 12 h of sudden-onset right-sided abdominal pain. The CT revealed the presence of multiple diverticula in the jejunum associated with diffuse wall thickening and marked peridiverticular inflammatory changes. This was most in keeping with small bowel diverticulitis, however, there was no definite extraluminal gas to suggest any evidence of perforation. The patient was managed conservatively with intravenous antibiotics and bowel rest. The patient’s pain improved with improving inflammatory markers during the hospital stay. The patient was discharged day 4 following the admission. We believe that there is a need to devise a comprehensive treatment guidelines specific for small bowel diverticulitis. In the meantime, it is deemed safe to conservatively manage uncomplicated cases without perforation. Key words: Intestine, small, abnormalities, abdomen, acute, diverticulosis, colonic, diverticulitis, colonic, clinical protocols, tomography, computed.