Laparoscopic small intestinal resection for perforated jejunal diverticulum

76 year old gentleman presented with acute abdominal pain and was diagnosed with bowel perforation on x ray abdomen. A CT scan of abdomen showed a large jejunal (part of small intestine) diverticulum (grape like outpouching) with signs of perforation. The patient was immediately taken up for laparoscopic surgery. The perforated jejunal diverticulum was identified. (Image) A small part of intestine with the perforated diverticulum was resected and intestinal ends were rejoined to establish intestinal continuity. There were many diverticula in the small intestine, but they were not resected as it is not necessary. Patient recovered well and was discharged in few days.

Emergency Laparoscopic small intestinal resections are less common as intestines are often distended, there is risk of abdominal contamination and there are space constraints. We have successfully performed many elective and emergency small intestinal resections laparoscopically.

Jejunal diverticulum is not very common. When present they may remain asymptomatic or cause nonspecific abdominal complaints like indigestion ,pain, bloating, loose motions or can cause acute problems like perforation or bleeding. Only symptomatic patients need treatment which invariably is surgery.