Jejunal diverticulosis: a potentially dangerous entity

Abstract

Although jejunal diverticulosis is a rare entity and usually asymptomatic, it may cause chronic symptoms and acute complications. Because of the rarity of the entity, diagnosis is often delayed, resulting in unnecessary morbidity and mortality. The purpose of this study was to draw attention to jejunal diverticula and their complications. The medical records of 8 consecutive patients with complications due to small-bowel diverticula treated at our department during the past 4 years were reviewed. All diverticula were located in the jejunum. Seven patients had acute complications, 3 patients had an intra-abdominal abscess, 2 had free perforation with diffuse peritonitis, 1 had a bowel occlusion and 1 patient had concomitant bleeding and occlusion. One patient presented with chronic symptoms. A preoperative diagnosis of jejunal diverticula, before explorative laparotomy, was not reached in any of the 7 patients with acute symptoms. In the patient with chronic symptoms, multiple jejunal diverticula complicated by a jejuno-colic fistula and foreign body were found at laparotomy. On patient died of multiorgan failure. Small-bowel diverticulosis is a rare entity, but it should not be regarded as a clinically insignificant finding. It may be difficult to make a preoperative diagnosis. Patients with incidentally detected proximal jejunal diverticula, at imaging studies or at laparotomy, warrant close observation and awareness that the diverticula may cause serious complications.

Jejunal diverticulae: reports of two cases with review of literature

“…Edwards noted 75% of these located in the proximal jejunum while only 5% were found in ileum [1]. Predominance of diverticulae in jejunum has been attributed to the larger caliber of vasa recta of jejunum [17,18] as JD are almost exclusively found on the mesenteric border, near the site of entry of blood vessels into the bowel wall [1,3,15,19,20].…”

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

“…7 The prevalence increases with the age and the disease presents a peak incidence at the sixth and seventh decades with a male predominance. 8 The size of small bowel diverticula varies. Diverticula may measure from few millimeters up to more than 3 cm.…”

A Rare Cause of Abdominal Pain: Jejunal Diverticulosis

“…The size of the diverticula can range from a few millimeters to more than ten centimeters. 4,8 They are usually larger and higher in number in the proximal jejunum compared to the distal small bowel. 4 Jejunal diverticulosis is generally not visible on plain radiograph images of the abdomen, 9 though distended jejunal loops may suggest its diagnosis.…”

“…7 Chronic malabsorption can present as an iron-deficiency anemia with microcytosis or a vitamin B12 deficiency with megaloblastosis. 8 Due to its varying presentations, jejunal diverticulosis and its complications, while largely asymptomatic, have the potential to cause significant medical morbidity.…”

“…14 The most definitive and agreed upon treatment of complicated jejunal diverticulosis is resection of all affected jejuna with a primary anastomosis, 4,8 which can alleviate symptoms of both acute and chronic complications. Complications requiring surgery have been reported in up to 10% of patients.…”