Shahid Majeed, Asif Saeed.
Perforated jejunal diverticulum.
Pak Armed Forces Med J Jan ;54(1):134-5.

A 50 years old male reported with history of pain upper abdomen of 03 days duration. The pain was localized to upper abdomen non-radiating, intermittent and dull in character. He had constipation for the last 2 days but no vomiting. There was history of flatulent dyspepsia off and on for the last 6 months for which he took antacids regularly. He never had melena or hematemisis. On physical examination, he was of average build, mildly dehydrated and was afebrile. Blood pressure was 120/90 mm Hg and pulse was 100/min. On abdominal examination there was tenderness and guarding in the right hypochondrium and right lumbar region but no distension. No mass or viscera was palpable. Bowel sounds were sluggish. Rectal examination revealed no abnormality. Chest x-ray revealed no free air under right diaphragm. He was kept nil orally and LV fluids started. Broad spectrum antibiotics (Inj cefotaxime sodium 1 gm bid IN with Inj metronidazole 500 mg tds IN) started. Blood Hb was 14.3 gm/dl with 65% neutrophils. LFTs, blood glucose, urea electrolytes were within normal range. Peritoneal tap in the right iliac region was positive. Exploratory laparotomy revealed perforated jejunal diverticulum about 35 cm from duodenojejunal junction. Diverticulectomy was performed and gut was closed with vicryl 2/0 in two layers. Patient had uneventful recovery and was discharged on 10th post operative day. Histopathology revealed ulcerated small bowel wall (Jejunum).

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