Diverticular Disease of the Small Bowel

Abstract

A diverticulum is a bulging sack in any portion of the gastrointestinal tract. The most common site for the formation of diverticula is the large intestine. Small intestine diverticular disease is much less common than colonic diverticular disease. The most common symptom is non-specific epigastric pain and a bloating sensation. Major complications include diverticulitis, gastrointestinal bleeding, acute perforation, pancreatic or biliary (in the case of duodenal diverticula) disease, intestinal obstruction, intestinal perforation, localized abscess, malabsorption, anemia, volvulus and bacterial overgrowth. We describe the clinical case of a 65-year-old female patient with a diagnosis on hospital admittance of acute appendicitis and a intraoperative finding of diverticular disease of the small intestine, accompanied by complications such as intestinal perforation, bleeding and abdominal sepsis. This was surgically treated with intestinal resection and ileostomy and a subsequent re-intervention comprising perforation of the ileostomy and stomal remodeling. The patient remained hospitalized for approximately 1 month with antibiotics and local surgical wound healing, as well as changes in her diet with food supplements and metabolic control. She showed a favorable clinical evolution and was dismissed from the hospital to her home. We include here a discussion on trends in medical and surgical aspects as well as early handling or appropriate management to reduce the risk of fatal complications.

Terminal ileal diverticulitis in disguise

“…Small bowel diverticulosis is often incidentally diagnosed through autopsy, barium studies or enteroclysis . First documented in 1794, the first resection was performed in 1906 .…”

“…Most patients are asymptomatic, with 10–20% developing complications . Chronic complications include pseudo‐obstruction and malabsorption secondary to bacterial overgrowth . With non‐pathognomonic symptoms of bloating, pain, diarrhoea or weight loss, it is often clinically missed due to more common conditions .…”

Non-Meckel's Small Bowel Diverticular Bleeding: Two Case Reports and a Review of the Literature

“…There is some evidence to suggest that periampullary diverticula can increase the risk of cholangitis 9. By contrast, up to 60% of non-Meckel’s jejunoileal diverticula may cause symptoms including small intestinal bacterial overgrowth, obstruction secondary to volvulus or enterolith impaction, diverticulitis, and abdominal pain 7,10,11. Hemorrhage, as was seen in our patients, is described in 3–8% of patients with non-Meckel’s jejunoileal diverticulosis 12,13…”

Ileus Caused by Large Diverticulum of Postbulbar Duodenum: Case Report

“…A diverticulum is an abnormal sac or pouch protruding from the wall of a hollow organ [1] [4]. Diverticular disease of the small intestine is relatively common.…”