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E-publishing of this PDF file has been approved by the authors. Emerg Care J 2025 [Online ahead of print] To cite this Article: Barakat M, Capone M, Lotrecchiano L. A rare trouble in the small bowel. Emerg Care J doi: 10.4081/ecj.2025.14261 ©The Author(s), 2025 Licensee PAGEPress, Italy Note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries should be directed to the corresponding author for the article. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. Submi&ed: 3 November 2025 Accepted: 15 December 2025 Early access: 18 December 2025 A rare trouble in the small bowel http://www.acemc.it/index.html https://www.pagepress.org/site Massimo Barakat,1 Mario Capone,2 Ludovica Lotrecchiano 1 1Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna; 2Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy Correspondence: Massimo Barakat, Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pietro Albertoni n° 15, Bologna, Italy. Tel.: +390512144327 E-mail: massimo.barakat@gmail.com Key words: jejunal diverticulitis, diverticula, small bowel, abdominal pain, computed tomography, abdominal surgery Contributions: MB conceptualized and wrote the manuscript. MC and LL drafted the report of the abdominal computed tomography scan. All Authors approved the final version of the manuscript. Conflicts of interest: the Authors declares no conflict of interest. Funding: none. Availability of data and materials: all data and materials are included in this published article. mailto:massimo.barakat@gmail.com Ethics approval and consent to participate: as this was a descriptive case report and data were collected without patient identifiers, ethics approval was not required under our hospital’s Institutional Review Board guidelines. Informed consent: the patient provided consent for the access to medical records at the time of admission. A 69-year-old woman presented to the emergency department with acute lower abdominal pain, peritonism and fever (body temperature 38.5 °C). Her past medical history was unremarkable. Laboratory tests revealed an increase of white blood cells (18.17 x 109/L; normal values 3.6-10.5 x 109/L), neutrophils (16.05 x 109/L; normal values 1.5-7.7 x 109/L), C-reactive protein (31.79 mg/dL; normal values < 0.5 mg/dL) and lactate dehydrogenase (315 U/L; normal values < 248 U/L) levels. Abdominal contrast-enhanced computed tomography (CT) scan showed a large outpouching filled by fecaloid material on the mesenteric side of a jejunal loop in the left lumbar region with stranding of adjacent fat (red arrow). Question Given the patient’s history and CT scan result, which is the most likely diagnosis? A. Jejunal diverticulitis B. Jejunal perforation with abscess on the mesenteric side C. Isolated jejunal Crohn’s disease with abscess on the mesenteric side D. Jejunal perforated neoplasm Answer Jejunal diverticulitis is the correct answer. Acquired jejunoileal non-Meckel diverticula are rare compared to large bowel diverticulosis (0.03% - 1% of general population).1 They are more common in males and their prevalence increases with age, peaking at the sixth and seventh decades.2 They are more frequent in the jejunum (80%), where they tend to be larger and higher in number.3 They occur in the context of intestinal dyskinesia, which causes an increase of segmental intraluminal pressure, leading to a mucosal and submucosal herniation through the weakest mesenteric site of the bowel wall along the area where the vasa recta and nerves penetrate the mesentery area (so they are properly false diverticula or pseudodiverticula, similarly to large bowel ones).4 Symptoms are usually absent (70%) or nonspecific (30%; abdominal pain, fever, nausea, vomiting and diarrhea), while complications develop in only 10% of patients (obstruction, bleeding, perforation, fistula or abscess formation).4,5 CT scan is considered the gold standard for the diagnosis of jejunoileal diverticulitis and its complications.2,6 Surgery is the preferred treatment option, especially in the presence of complications.7 Conservative treatment may be attempted in the absence of complications.8 In our case, at laparotomy the diverticulum wall was ischemic with focal perforation. Because other not inflamed diverticula were seen in the neighboring jejunal loops both by laparoscopy and CT scan, a wide jejunal resection with isoperistaltic jejunoileal anastomosis was performed. Full recovery was achieved, and the patient was discharged after seven days of hospitalization. References 1) Rajaguru K, Sheong SC. Case report on a rare cause of small bowel perforation perforated ileal diverticulum. Int J Surg Case Rep 2021;87:106465. 2) De Simone B, Alberici L, Ansaloni L, et al. Not all diverticulites are colonic: small bowel diverticulitis - A systematic review. Minerva Chir 2019;74:137-45. 3) Jeong J, Hong SS, Hwang J, et al. Acute diverticulitis of the terminal ileum: ultrasonography and CT findings. Ultrasonography 2015;34:74–7. 4) Bellio G, Kurihara H, Zago M, et al. Jejunoileal diverticula: a broad spectrum of complications. ANZ J Surg 2020;90:1454-8. 5) Jawed A, Jawed A, Kumari S, Shaikh OA, Nashwan AJ. A rare case of perforated jejunal diverticula of an uncommon origin. Clin Case Rep 2023;11:e7206. 6) Comune R, Liguori C, Guida F, et al. Left side jejunal diverticulitis: US and CT imaging findings. Radiol Case Rep 2024;19:2785-90. 7) Park HC, Lee BH. The management of terminal ileum diverticulitis. Am Surg 2009;75:1199–202. 8) Ejaz S, Vikram R, Stroehlein JR. Non-Meckel small intestine diverticulitis. Case Rep Gastroenterol 2017;11:462–72.