JEJUNAL DIVERTICULOSIS- A RARE PRESENTATION

Jejunal diverticulosis is a rare condition with incidence rate less than 0.5 percent. The prevalence of castleman's disease is also equally rare with the figures stating 1 per 100,000.Both the above conditions are equally rare entities among themselves and thus when they present together is truly a diagnostic challenge. This is a case who presented with symptoms of subacute intestinal obstruction and abdominal pain. Emergency ultrasound was done for the same which came back as suspicious of mesenteric ischaemia. Hence laparotomy was done suspecting bowel gangrene. On opening up multiple jejuna diverticula were seen which were mildly inflammed but no signs of rupture were seen. Along with this multiple tiny 1x1 cm sized mesenteric lymph nodes were seen, which were biopsied. Histopathology of the nodes were reported as castleman's disease. Since the diverticula were not ruptured a thorough wash was given with saline and the abdomen was closed after putting flank drains. Jejunal diverticula are the least common and in fact represent the rarest localization of diverticular disease. Castleman's disease is is a very rare disorder characterized by non cancerous tumors that develops in asingle lymph node or throughout the body.Both the above conditions when combined together represents a very rare finding. In a country like India where tuberculosis is very common one should also keep in mind other differential diagnosis such as castleman's disease in a setting of mesenteric lymph node enlargement.