UNCOMPLICATED DIVERTICULOSIS OF THE SMALL BOWEL - RARE CAUSE OF ACUTE ABDOMEN

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Male patient, 76 years old, has been accusing diffuse abdominal pain of about 12 hours. Clinical examination: stable haemodynamic and respiratory, with a scar-free abdomen, slightly elusive, painfully spontaneous and palpable, with a muscular defence sketch. Biological: leukocytosis 17000 / ml. Abdominal ultrasound: the fine liquid blade in Douglas. Simple abdominal radiography: hydro-aeric levels of the small intestine. Having the diagnosis of acute abdomen due to the undetermined cause, an exploratory laparotomy is performed that detects: diffuse distension of small bowel, showing relatively bulky sacral/diverticular dilatations, disposed on the mesenteric margin, dispersed over almost the entire length of the jejunum without signs of inflammation or perforation. Exploration of the rest of the peritoneal cavity does not detect other lesions, so we have no other explanation for patient symptomatology. Favourable postoperative progression. At 6 months and 1-year control, the patient reports only short episodes of abdominal discomfort remission under symptomatic treatment. Acquired intestinal diverticulosis is an extremely rare entity, with a prevalence of between 0.073% and 1.3% [1]. Localization is at the level of the jejunum (80%), ileum (15%), and very rarely in the entire small intestine (5%) [2]. Clinically, diverticulosis is asymptomatic in most cases, may display nonspecific dyspeptic symptoms and may be complicated by inferior digestive haemorrhage, inflammation or perforation [1]. Aetiology is not fully elucidated, but research on pathophysiological mechanisms has led to the hypothesis of mucosal and sub-mucosal herniation where the arteries permeate the muscular layer as a result of intraluminal pressure increase [3].