Clinical implications of jejunoileal diverticular disease

Abstract

Congenital and acquired diverticula of the jejunum and ileum in the adult are unusual and occur in approximately 1 percent to 2 percent of the population. They are pulsion diverticula thought to be the result of intestinal dyskinesia. These lesions can produce a significant diagnostic and therapeutic dilemma. They are multiple in the jejunum and solitary distally and are characteristically found in 60- or 70-year-old males. The diagnosis may be confirmed with contrast studies of the small intestine, arteriography, or nuclear scan. Consider these disorders in patients with 1) unexplained gastrointestinal bleeding, 2) unexplained intestinal obstruction, 3) an unexpected cause of acute abdomen, 4) chronic abdominal pain, 5) anemia, or 6) malabsorption. Medical therapy is helpful in controlling diarrhea and anemia, while surgical therapy is reserved for hemorrhage, obstruction, perforation, or failure of medical management. Asymptomatic diverticula discovered on routine contrast studies need not be resected. At surgery, incidental diverticula should be removed when evidence of dilated, hypertrophied loops of small bowel with large diverticula is found. Intraoperative air distention will aid in diagnosis. Resection and primary anastomosis is the preferred treatment for non-Meckelian diverticula. Diverticulectomy is reserved for a Meckel's diverticulum without evidence of ulceration. An incidental Meckel's diverticulum should be removed in the presence of mesodiverticular bands or ectopic tissue. Removal of a Meckel's diverticulum is not advised in the patient with Crohn's disease but may be performed in the patient undergoing restorative proctocolectomy for ulcerative colitis.

Multiple jejunal diverticulitis presenting with acute intestinal obstruction: a diagnostic dilemma

“…2 The first instance of jejunal diverticulosis was reported by Sir Astley Cooper. 3 Gordinier and Sampson published the first account of an operation for small bowel diverticula.…”

Jejunal Diverticulosis Cases Involving Massive Gastrointestinal Bleeding and Diagnosed Incidentally: A Report of Two Cases

“…However, symptoms such as nonspecific stomach pain, dyskinesia, chronic anemia, and malabsorption are sometimes observed, and 15% of patients who develop complications may need surgery. 3,5 It is difficult and sometimes not possible to diagnose preoperative hemorrhage of jejunal diverticulosis. In many studies, techniques such as selective angiography, nuclear scanning, endoscopic analysis, and contrast-radiology examination have been used to localize the site of the hemorrhage.…”

“…3,8 Nonetheless, challenges remain for its diagnosis and treatment, including difficulty in intraoperative diagnosis and lack of knowledge of the pathology of hemorrhage in the diverticular of the small intestine. Fortunately, diagnosis is generally possible by means of histopathologic examination, and two mechanisms have been proposed with regard to the etiology.…”

A Rare Cause of Abdominal Pain: Jejunal Diverticulosis

“…However, 30% of patients present with vague abdominal symptoms. 12 Reported symptoms include dull mid-epigastric pain, 9 post-prandial pain, nausea, vomiting, abdominal bloating, 4,10 and chronic diarrhea resulting from small bowel bacterial overgrowth. 9 Unfortunately, the physical exam may be non-specific and the diagnosis heavily relies upon imaging studies.…”

“…12 However, it should not be excluded from the differential in patients presenting with chronic abdominal pain and bowel changes. A suggested triad of obscure pain, anemia, and dilated loops of bowel on barium radiograph can be used to evaluate jejunal diverticulosis.…”