Perforated jejunal diverticulitis in the setting of biologic therapy presenting as transverse Colon diverticulitis: A case report

• Published in: International journal of surgery case reports 2024-05, Vol.118, p.109615, Article 109615
• Main Authors: Dourado, Justin, Jassir, Fauzi Feris, Pavlovsky, Arthur, Blumofe, Karin
• Format: Article
• Language: English
• Subjects: Biologic therapy; Case Report; Immunosuppression; Misdiagnosis; Perforation; Small bowel diverticula
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2024.109615

Small bowel diverticula are a rare entity and are mostly found in the duodenum on diagnosis. Some common complications of this pathology include bleeding, obstruction, diverticulitis, and perforation. Furthermore, there is growing evidence supporting an association between biologic therapies and spontaneous intestinal perforation. We present a case of a 79-year-old female on prednisone, hydroxychloroquine, and tofacitinib for rheumatoid arthritis who was misdiagnosed with transverse colonic diverticulitis and eventually found to have perforated jejunal diverticulitis on laparotomy. While tofacitinib has been associated with spontaneous intestinal perforation, it has not been documented as an aggravating factor in small bowel diverticular disease. It is imperative to maintain a high index of suspicion for this pathology in immunosuppressed patients with an atypical presentation of diverticular disease. •Small bowel diverticula are a rare entity that can be diagnosed incidentally or via symptoms.•Biologic therapies have been linked with spontaneous intestinal perforation.•These therapies can affect perforation of small bowel diverticula which is a commonly missed diagnosis.•A high index of suspicion is necessary with atypical presentations or a misdiagnosis of colonic diverticulitis.