Diagnosis and Nonoperative Management of Uncomplicated Jejunal Diverticulitis: A Case-Based Review
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThis manuscript, titled 'Diagnosis and Nonoperative Management of Uncomplicated Jejunal Diverticulitis: A Case-Based Review,' presents a well-structured case report highlighting a rare instance of small bowel diverticulitis. The authors successfully document the clinical presentation, diagnostic workup, and conservative management of the disease.
Below are my comments:
The abstract is well-structured but lacks a sentence about the outcome significance for clinical practice (e.g., why this case is important to publish).
The introduction summarizes diverticular disease well but lacks clarity on why jejunal diverticulitis is particularly rare or clinically challenging.
The case is clearly described but lacks detail on differential diagnosis considered upon presentation.
The discussion is comprehensive but could benefit from a comparative table summarising key features of colonic vs. small bowel diverticulitis (incidence, presentation, treatment differences).
The modified Hinchey classification is presented, but it's specific to colonic diverticulitis; a comment on its limitations for small bowel diverticulitis would be valuable.
Overall, the case is well-presented, and the manuscript is informative. However, there are several areas above where the clarity, depth of discussion, and overall impact can be enhanced to further improve the quality of this submission
Author Response
Comments 1- The abstract is well-structured but lacks a sentence about the outcome significance for clinical practice (e.g., why this case is important to publish).
Response 1- Thank you for your comment. Therefore, we have added some verbiage to the last sentence of the abstract to clarify the clinical significance of the pathology we discuss.
Comments 2- The introduction summarizes diverticular disease well but lacks clarity on why jejunal diverticulitis is particularly rare or clinically challenging.
Response 2- We appreciate your comment. In the introduction paragraph 1 sentence 2, we state that 95% of diverticula form within the sigmoid colon. In the introduction paragraph 2 sentences 1-2 and the discussion paragraph 1 sentence 3, we further clarify the rarity of small bowel diverticulitis. We hope that the compilation of data and information we present reflects the rarity of jejunal diverticulitis.
Comments 3- The case is clearly described but lacks detail on differential diagnosis considered upon presentation.
Response 3- Thank you for pointing this out. In the discussion in paragraph 5 sentence 2 we include potential differential diagnoses for this patient’s presentation. Due to the wide array of abdominal pathologies, we decided to focus the differential diagnosis on pathologies that have been associated with diverticular disease in prior literature.
Comments 4- The discussion is comprehensive but could benefit from a comparative table summarising key features of colonic vs. small bowel diverticulitis (incidence, presentation, treatment differences).
Response 4- Thank you for your thoughts. While we appreciate the idea of a table summarizing the key features of colonic versus small bowel diverticulitis, we believe that due to the rarity and lack of universal guidelines for the treatment of small bowel diverticulitis that the table would not be beneficial to the reader and would skew the table with information on colonic diverticulitis. We hope that our robust discussion of small bowel diverticulitis and the existing literature helps to shed light on future management strategies.
Comments 5- The modified Hinchey classification is presented, but it's specific to colonic diverticulitis; a comment on its limitations for small bowel diverticulitis would be valuable.
Response 5- We thank you for your apt comment. Therefore, in the Discussion in paragraph 3, we have edited the paragraph to reflect the limitations of the Hinchey classification to small bowel diverticulitis and commented on the lack of a current formal classification system specific to small bowel diverticulitis.
Comments 6- Overall, the case is well-presented, and the manuscript is informative. However, there are several areas above where the clarity, depth of discussion, and overall impact can be enhanced to further improve the quality of this submission.
Response 6- We appreciate your comments and feedback. We hope that the changes we have made that incorporate our reviewers’ feedback improve the clarity, discussion, and overall impact of the submission.
Reviewer 2 Report
Comments and Suggestions for AuthorsThe authors proposed a rare case, jejunal diverticulitis with common presentation, such as abdominal pain, fever, and nausea.
They had been pointing out the important learning lessons and comprehensive literature reviews.
However, there were some wrong words that need to be correct.
Example 1.abstract line 2 ened
Author Response
Comments 1- The authors proposed a rare case, jejunal diverticulitis with common presentation, such as abdominal pain, fever, and nausea. They had been pointing out the important learning lessons and comprehensive literature reviews. However, there were some wrong words that need to be correct. Example 1.abstract line 2 ened
Response 1- We thank you for your feedback. We hope that throughout the writing and reviewing process that we limit errors in our spelling, grammar, and punctuation. We have reviewed the specific example that you pointed out and do not believe that there is a visible error that we are aware of. Clarification on your comment if edits are necessary would be appreciated.
Reviewer 3 Report
Comments and Suggestions for AuthorsThis is a well-structured and informative case report describing a rare presentation of jejunal diverticulitis. The authors provide a clear discussion of the clinical scenario, diagnostic workup, imaging findings, and treatment, with good contextualization in the literature. The case is well-suited for publication with minor revisions.
- Clarify Rationale for Antibiotic Choice
The choice of amoxicillin-clavulanate is reasonable, but a brief mention of its spectrum and justification would be useful. - Age Range and Epidemiology
The patient’s age (48) is younger than the average for jejunal diverticulitis; the authors mention this but could elaborate briefly on why it’s relevant diagnostically. - More Focused Take-Home Message
The conclusion could be sharpened by emphasizing the clinical decision-making pathway that led to avoiding surgery.
With small improvements in the discussion, this case report will make a valuable contribution to the literature on rare GI presentations.
Author Response
Comments 1- The choice of amoxicillin-clavulanate is reasonable, but a brief mention of its spectrum and justification would be useful.
Response 1- Thank you for your feedback. We have added to the Discussion paragraph 7 sentence 2 a description of the antibiotic, mechanism, antibiotic coverage, and justification of our case.
Comments 2- The patient’s age (48) is younger than the average for jejunal diverticulitis; the authors mention this but could elaborate briefly on why it’s relevant diagnostically.
Response 2- We appreciate your comment. In the first sentence of the Conclusion, we emphasize the importance of consideration of a wide range of GI pathologies, especially in a patient who does not fit the classic demographic or clinical presentation. We hope that this clarification helps to shed light on why this is relevant to our case.
Comments 3- The conclusion could be sharpened by emphasizing the clinical decision-making pathway that led to avoiding surgery. With small improvements in the discussion, this case report will make a valuable contribution to the literature on rare GI presentations.
Response 3- We thank you for your apt comment. In the Conclusion, we have added sentence 4 to highlight the timely diagnosis that allowed the patient to avoid surgical intervention, possible complications, or a lengthy hospital stay due to non-operative management. We believe that this sentence will highlight the importance of our report and hope that this clarification reflects that.
