International Journal of Basic and Applied Medical Sciences ISSN: 2277-2103 (Online) An Online International Journal Available at http://www.cibtech.org/jms.htm 2013 Vol. 3 (3) September-December, pp.203-207/Aghajanzadeh et al. Case Report 203 PERFORATED JEJUNALDIVERTICULA IN A PATIENT WITH MULTIPLE GIANT DIVERTICULA OF THE DUODENUM AND JEJUNUM: A CASE REPORT Aghajanzadeh M., Hemmati H., Asgari M., Esmaeli Delshad M., Khedmatkar B., Shojaee R. and Massahnia S. Pulmonary Diseases & TB Research Center of Guilan University Medical Sciences, Razi Hospital, Rasht, Iran *Author for Correspondence ABSTRACT Multiple diverticulosis of duodenum and jejunum are very uncommon pathology of the small bowel. The disease is usually asymptomatic and in some cases present with unexplained malbsorption, anemia, chronic abdominal pain or discomfort. Complications such as diverticulitis, perforation, bleeding or intestinal obstruction appear in 10-30% of the patients and increasing morbidity and mortality rates. We herein report a case of a 72 year-old man which presented with vomiting, intermittent upper abdominal pain, distension and obstipation since nine days before admission. Preoperative radiologic and an abdominal computed tomography scan examination revealed multiple air fluid in the abdominal cavity and bilateral polycystic kidney. An emergency laparotomy was carried out which revealed multiple duodenum and jejunal diverticula, one of jejunal diverticula had been perforated and causing peritonitis. Segmental resection of jejunum perforation site was performed and patient discharged uneventfully. Multiple Jejunal diverticulosis in the elderly can lead to significant morbidity and mortality and so should be suspected in those presenting with crampy abdominal pain and altered bowel habits. INTRODUCTION Jejunal diverticulosis is a rare condition with variable clinical and anatomical presentations, But Multiple diverticulosis of duodenum and jejunum are very uncommon (Singal et al., 1991). The prevalence of small intestinal diverticula on autopsy ranges from 0.06% to 1.3% (Woubet et al., 2007). Most small bowel diverticula are thought to be acquired pulsion lesions (Singal et al., 2012). The majority of jejunal diverticulosis cases are discovered incidentally during radiological investigations (0.02% and 2.3%) (Benya et al., 1991). The clinical presentations of acquired jejunoileal diverticulosis are vague and diverse. Presenting complaints such as intermittent abdominal pain, constipation and diarrhe have been demonstrated in up to 90% of the patients and imaging tests have mostly atypical appearance and may not correlate with the clinical symptoms (Woubet et al., 2007; Benya et al., 1991). Diagnostic tools are plain abdominal X-ray series, Barium follow-through study and enteroclysis, Computed tomography and Multi slice CT (Benya et al., 1991; Bitterling et al., 2003). There is some contravesia on the management of asymptomatic jejunal diverticular disease, if asymptomatic diverticula found incidentally during laparotomy for other reasons, should be left alone (Singal et al., 2012). Some complications are potentially life threatening and require early surgical treatment (Wojciech et al., 2008). Surgical exploration is the treatment of choice for almost all acute complicated cases (Wojciech et al., 2008). We report a symptomatic case of diffuse jejunum diverticulosis simultaneously affecting duodenum and bilateral polycystic kidney. CASES A72-year-old man presented to the emergency department with nine day history of generalized abdominal pain, with multiple episodes of vomiting. The patient had a past medical history of open prostatectomy and umbilical hernia operations. On physical examination: a temperature 38°C, heart rate 105, blood pressure 120/70 and respiratory rate 18 breaths/min. abdominal examination revealed a mild generalized abdominal tenderness and distension. Laboratory investigations revealed an elevated white blood cell