Rare Presentation of Small Bowel Diverticula: A Novel Case Report and Insights Into Diagnostic Dilemmas and Clinical Spectrum.

Small bowel diverticulosis is an uncommon condition with a broad spectrum of clinical presentations, often challenging to diagnose and manage. This report presents a 38-year-old male patient who initially presented with vague, colicky abdominal pain that acutely intensified, accompanied by pneumoperitoneum on imaging. Exploratory laparotomy revealed multiple diverticula in the jejunum and ileum, with a perforated jejunal segment, which was surgically resected. Despite subsequent conservative management, the patient continued to experience intermittent abdominal pain and recurrent pneumoperitoneum on imaging over a two-year follow-up, eventually requiring a second laparotomy for a perforated diverticulum. Postoperatively, he experienced additional complications, including incisional hernias. This case underscores the diagnostic challenges and need for individualized management in small bowel diverticulosis, where both conservative and surgical strategies may be required to balance symptom relief and prevent recurrence.