Jejunal diverticulosis is a rare condition that is often asymptomatic but can lead to serious complications such as diverticulitis, perforation, and intra-abdominal abscess. Due to its rarity and nonspecific clinical presentation, diagnosis is often delayed, increasing morbidity and mortality.

We report the case of a diabetic patient with a history of abdominal surgery who presented with upper abdominal pain that had been evolving for five days. The clinical examination was nonspecific and the patient was hemodynamically stable. Laboratory tests revealed a marked inflammatory response and acute renal failure. Abdominal computed tomography revealed a large mesenteric abscess adjacent to the first jejunal loop, associated with necrotic and perforated jejunal diverticula. Emergency surgery revealed multiple perforated jejunal diverticula with segmental intestinal necrosis and a mesenteric abscess. Segmental jejunal resection with primary end-to-end anastomosis was performed. Postoperative recovery was favorable.

Perforated jejunal diverticulitis is a rare but potentially fatal cause of acute abdomen. Imaging, particularly computed tomography, plays a key role in diagnosis. Surgical resection of the affected intestinal segment with primary anastomosis remains the treatment of choice in complicated cases, while extensive resection should be avoided in order to prevent short bowel syndrome.

Jejunal diverticulitis should be considered in the differential diagnosis of acute abdomen, particularly in patients who have undergone previous abdominal surgery and present with signs of inflammation. Early diagnosis and prompt surgical management are essential to improve outcomes in this rare condition.