Perforated jejunal diverticulitis in a Jehovah's Witness complicated by postoperative haemorrhage: a case report of successful bloodless management.

While colonic diverticulosis affects approximately half of adults over 60 years of age in Western populations, jejunal diverticulosis are rare with a reported prevalence of 0.2%-1.9% associated with high mortality rate (up to 40%) when presented as complicated. Performing lifesaving surgery while respecting patient's autonomy and informed refusal of blood transfusion represents a challenge on its own for the medical team. We present a case of a 74-year-old Jehovah's Witness man who was diagnosed intraoperatively with perforated jejunal diverticulitis. Emergency laparotomy with segmental jejunal resection and primary anastomosis was performed. On the fifth postoperative day the patient developed post-operative haemorrhage secondary to laparotomy disruption with omental tearing, requiring urgent reoperation. Despite refusing allogenic blood transfusion, blood loss was successfully managed without transfusion. Post-operative anemia was treated with intravenous iron, vitamin B12, Folic acid, and supportive care which resulted in gradual improvement. The patient was discharged on post-operative Day 11. This case highlights that successful management of perforated jejunal diverticulitis and post-operative haemorrhage is feasible in Jehovah's Witness patient through prompt surgical intervention, meticulous haemostasis, and bloodless postoperative anaemia treatment. To our knowledge, this is the first reported case of perforated jejunal diverticulitis in a Jehovah's Witness patient.