Small bowel diverticulitis: an often overlooked cause of acute abdomen

Abstract

We present 3 cases of small bowel diverticulitis ultimately presenting to our Emergency Department over a span of 2 years. Though the final diagnosis was the same, each patient's symptomatology was different, mimicking more common pathologies. Thus, it is important to consider this entity when confronted with signs and symptoms of acute abdomen, especially in the elderly. A missed or delayed diagnosis can lead to costly erroneous studies, incorrect treatments and delay in proper management, resulting in significant morbidity and even mortality. The variety of presentations can often be misleading; therefore, a high index of suspicion is needed on the part of the Emergency Department physician and Radiologist.

Small bowel diverticula in elderly patients: a case report and review article

“…While radiographs can reveal features such as free air under the diaphragm or others [ 1 , 8 , 11 , 13 – 18 ], many were unremarkable [ 5 , 6 , 9 , 19 – 23 ]. However, CT imaging is a more reliable method of diagnosis and was able to show the features of this entity in all cases when it was obtained [ 1 , 4 , 7 , 9 , 10 , 13 , 15 , 17 , 22 – 28 ]. A diagnostic laparoscopy was also done in some cases [ 4 – 6 , 8 , 12 , 14 , 15 , 19 – 21 , 26 , 29 ].…”

Multiple giant jejunal diverticulosis: A rare clinical presentation of a rarely encountered disease

“…[4,6,11] Compared to duodenal diverticula, jejunoileal diverticula have a four-fold greater risk of general complications and an 18-fold greater risk of perforation. [4,15] Therefore, if diagnosis is not possible with clinical and endoscopic findings in patients with a history of abdominal surgery who have complaints such as abdominal pain, bloating and vomiting after eating, evaluation with CT [16] may be necessary to assess small intestinal diverticulum, especially proximal jejunal diverticulum. It should be kept in mind that these diverticulum may be large and multiple.…”

Jejuno-ileal diverticulitis: A disorder not to underestimate

“…Distal jejunum and ileum are co-affected in 20% and 5% of the cases, while 30%–75% of the patients present coexistent diverticula in the colon [8]. Approximately 0.07–1.0% of the population is reported to have jejuno-ileal diverticula; however, it is believed that the numbers are probably an underestimation of the true incidence [9]. The condition is usually clinically silent, as a matter of fact, it has been estimated that only 29% of the patients complains symptoms or signs, usually related to malabsorption and therefore associated to dyspepsia, abdominal discomfort and anemia [5].…”

“…The condition is usually clinically silent, as a matter of fact, it has been estimated that only 29% of the patients complains symptoms or signs, usually related to malabsorption and therefore associated to dyspepsia, abdominal discomfort and anemia [5]. Between patients with duodenal and jejuno-ileal diverticula, 10% of them will go through complications, especially those with jejuno-ileal diverticula, that, in comparison with individuals with duodenal diverticula, are four times more likely to have a general complication and about 18 times more likely to develop a perforation [9]. Acute complications are related to the inflammation of the mucosa, that leads to its perforation and subsequent abscess, massive hemorrhages or intestinal obstruction.…”