Complicated small-bowel diverticulosis: A case report and review of the literature

Abstract

While jejunoileal diverticula are rare and often asymptomatic, they may lead to chronic non-specific or acute symptoms. The large majority of complications present with an acute abdomen similar to appendicitis, cholecystitis or colonic diverticulitis but they also may appear with atypical symptoms. As a result, diagnosis of complicated jejunoileal diverticulosis can be quite difficult, and may solely depend on the result of surgical exploration. In the absence of contra-indications, diagnostic laparoscopy has the benefit of thorough examination of the abdominal contents and helps to reach an absolute diagnosis. Surgical resection of the involved small-bowel segment with primary anastomosis is the preferred treatment in patients with symptomatic complicated jejunoileal diverticular disease. An atypical presentation of complicated jejunal diverticulitis in conjunction with sigmoid diverticulitis diagnosed with laparoscopy and treated with surgical resection is presented.

Jejunal diverticulae: reports of two cases with review of literature

“…Also to add, these histological fi ndings are consistent with GI motility disorders like progressive systemic sclerosis, visceral myopathy and visceral neuropathies [7]. In fact, JD can be seen in elderly people with peristaltic disorders, such as progressive systemic sclerosis, leading to intestinal obstruction which in turn causes retention of faeces or gas in distal bowel, producing increased intraluminal pressure [4,7]. Increased intraluminal pressure acts at the weakest points in the muscle layers of jejunum i.e.…”

“…Microscopic examinations of JD specimens have shown that fi brosis along with degeneration or decrease in number of normal muscle cells, or, de- generation of neurons occurring in intestinal wall underlies these dysfunctions. Also to add, these histological fi ndings are consistent with GI motility disorders like progressive systemic sclerosis, visceral myopathy and visceral neuropathies [7]. In fact, JD can be seen in elderly people with peristaltic disorders, such as progressive systemic sclerosis, leading to intestinal obstruction which in turn causes retention of faeces or gas in distal bowel, producing increased intraluminal pressure [4,7].…”

“…By defi nition, the wall of a true diverticulum of intestine is composed of the entire thickness of the intestine; the false diverticulum, actually, on the other hand, represent a herniation of the mucosa and submucosa (Fig. 3) through the muscular coat of the intestine [1,7,9]. Therefore, a true diverticulum has all three coats of the gut, while a false one has mucosa and serosa only, with intervening connective tissue [9].…”

“…JD are false and acquired [2,3] with a prevalence rate of 0.3-2.3% [4][5][6]. Majority of people with JD are asymptomatic or have minor, non-specifi c gastrointestinal (GI) symptoms, and found incidentally on imaging studies or exploratory laparotomy done for other reasons [3,7]. The disease is clinically signifi cant because of associated potential risk of serious complications [8].…”

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

“…4,5 This explains their typical location at the mesenteric side. 1,4,6 Diverticula are more frequent in jejunum (61%) than the other parts of the small bowel and it is attributed to the greater diameter of the penetrating jejunal artery. 5 Coexistent diverticuli are found in many other digestive localization.…”