Perforated ileal diverticulitis. An atypical presentation with definitive diagnosis by laparoscopy.

An atypical presentation of ileal diverticulosis definitively diagnosed and treated with laparoscopy is presented. While jejunoileal diverticula are often asymptomatic, they may lead to chronic or acute symptoms. The large majority of complications secondary to small-bowel diverticulitis present with an acute abdomen similar to appendicitis but they also may appear with atypical symptoms. As a result, identification of jejunoileal diverticulosis can be quite difficult and surgery is often required in order to reach an absolute diagnosis. Surgical exploration, resection of the involved segment, and primary reanastomosis may be indicated in instances of symptomatic diverticular disease of the small bowel. Current laparoscopic techniques make this procedure well suited for both diagnosis and treatment of jejunoileal diverticula. In this report, the surgical incision was directed and limited under laparoscopic guidance while still allowing the benefit of thorough examination of the abdominal contents.