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Fatal complication of coincidental operative finding

A 65-year-old man with an established diagnosis of Crohn's colitis presented as an emergency with peritonitis and free subdiaphragmatic air on erect chest X-ray. At laparotomy, a grossly distended colon was noted, with two sites of perforation at the rectosigmoid and splenic flexure areas. Multiple non-dilated jejunal diverticula were noted coincidentally. Subtotal colectomy with cross-stapling of the rectum and formation of an end ileostomy was performed. He made an uneventful early postoperative recovery but during the fourth postoperative week he developed intermittent, colicky abdominal pain, vomiting and reduced ileostomy output. Subacute small bowel obstruction secondary to adhesions was diagnosed after clinical and radiological examination. Conservative treatment with intravenous fluids and nasogastric decompression produced an initial improvement but on the 32nd postoperative day the patient suddenly collapsed and died from a cardiorespiratory arrest secondary to acute renal failure and septic shock. At post-mortem examination, evidence of proximal jejunal diverticular disease with signs of acute diverticulitis and perforation were noted along with widespread peritonitis. No histological features of Crohn's disease were identified in the segment of perforated jejunum, or elsewhere in the bowel, and the inflammatory …