A 71-year-old woman with a history of arterial hypertension, renal transplant and choledocholithiasis presented to the emergency department with a 24-hour history of fever, more intense abdominal pain in the left iliac fossa, liquid diarrhoea without pathological products and occasional alimentary vomiting.
On examination, the patient was febrile, haemodynamically stable, well hydrated, eupneic and normal colour. The abdomen was soft and depressible, with pain on deep palpation, without clear focalisation and without signs of peritoneal irritation.
Additional tests included a blood test that showed discrete leukocytosis (10,200/μl) with a CRP of 2 mg/dl, neutrophilia, and a plain abdominal X-ray that was normal. In view of the suspected diagnosis of acute diverticulitis, an abdominal CT scan was performed, showing some diverticula in the small intestine, with evidence of a 16 mm diverticulum in the jejunum, with inflammatory signs and a high-density foreign body in its interior with a "Y" morphology, suggesting an animal bone as the first diagnostic possibility. A millimetre-sized bubble of pneumoperitoneum and inflammation of the adjacent fat were also observed adjacent to the diverticulum, these findings being compatible with acute perforated diverticulitis of the small intestine with a foreign body inside the diverticulum.

With these results and in view of the patient's acceptable general condition, she was admitted to the ward for treatment with digestive rest, broad-spectrum intravenous antibiotherapy (Imipenem 500 mg every 6 hours) and observation. During the stay, the patient's fever improved but the abdominal pain persisted, so scheduled surgery was decided.
During the operation, multiple diverticula were found in the jejunum, one of them with inflammatory signs, but without intra-abdominal abscesses. The gallbladder appeared distended and the common bile duct was larger than 1 cm in diameter. Intestinal resection with reconstruction by laterolateral anastomosis, cholecystectomy and exploration of the biliary tract were performed after confirmation of choledocholithiasis by cholangiography, extracting the stone and leaving a 4 mm Kehr drain in the common bile duct.

The immediate postoperative period was uneventful, reintroducing the diet with good tolerance and digestive transit. A trans-Kehr cholangiography was performed, which showed the absence of choledocholithiasis. On the tenth postoperative day, the patient had sudden abdominal pain associated with hypotension and elevated pancreatic enzymes and was transferred to the ICU with a diagnosis of moderate acute pancreatitis, dying 24 hours later as a result of multi-organ failure.

