ACUTE ABDOMEN • SENIOR RESIDENT / SURGEON

Small Bowel Diverticulitis

Jejunal or ileal diverticulitis can imitate other acute-abdomen diagnoses and may progress to abscess or perforation.

PROTOTYPE REVIEW REQUIRED

The Call

Older adult with focal abdominal pain and fever

CT shows focal small-bowel wall inflammation adjacent to a diverticulum with localized mesenteric stranding.

Stable initially

The key distinction is uncomplicated localized inflammation versus perforation, abscess or diffuse peritonitis.

Read the Image • Clinical Data

CT Abdomen Look for a focal small-bowel diverticulum with surrounding inflammatory change and assess for free air or abscess. Clinical image slot reserved for this case.

Make the Decision • Commit to a Plan

Small Bowel Diverticulitis

Older adult with focal abdominal pain and fever

CT shows jejunal diverticulitis with contained microperforation, no diffuse peritonitis and stable physiology. Best initial approach?

The patient worsens and laparotomy shows a perforated jejunal diverticulum with adjacent diseased segment. Best principle?

After resection the patient has persistent ileus, fever and localized tenderness. Best next step?

Find the diseased segment and control contamination.

Confirm the diagnosis and the source.

Surgical Pearls

Pitfalls

CT shows focal jejunal diverticulitis without free air, abscess or peritonitis in a stable patient. What determines whether surgery is needed?