Non-Meckel Small Intestine Diverticulitis

Abstract

Non-Meckel small intestine diverticulitis can have many manifestations and its management is not well-defined. We report 4 unselect cases of small intestine diverticulitis; all patients were seen by the same physician at the Emergency Center at The University of Texas MD Anderson Cancer Center between 1999 and 2014. The median age at diagnosis of these patients was 82 years (range, 76–87 years). All 4 patients presented with acute onset of abdominal pain, and computed tomography scans showed characteristics of small intestine diverticulitis unrelated to cancer. Most of the diverticula were found in the region of the duodenum and jejuno-ileal segments of the small intestine. The patients, even those with peripancreatic inflammation and localized perforation, were treated conservatively. Non-Meckel diverticulitis can be overlooked in the initial diagnosis because of the location of the diverticulosis, the age of the patient, and the rarity of the disease. Because patients with non-Meckel small intestine diverticulitis can present with acute abdominal pain, non-Meckel small intestine diverticulitis should be considered in the differential diagnosis of patients with acute abdominal pain, and computed tomography scans can help identify the condition. Because of the rarity of non-Meckel small intestine diverticulitis, few studies have been published, and the data are inconclusive about how best to approach these patients. Our experience with these 4 elderly patients indicates that non-Meckel small intestine diverticulitis can be treated conservatively, which avoids the potential morbidity and mortality of a surgical approach.

Small Intestinal Diverticulosis: A Rare Cause of Intestinal Perforation Revisited

“…In contrast to large bowel diverticulae, those arising in the small bowel are quite uncommon, with the frequency of prevalence as well as the number of diverticulae descending from the duodenum (0.02% to 6%) to the jejunoileum (0.07% to 1%), with only 2.3-6.4% of these patients going on to develop diverticulitis [ 3 , 4 ]. Most small bowel diverticulae produce no symptoms unless complicated by inflammation, perforation, bleeding, small bowel obstruction, or malabsorption [ 5 ]. Complications were noted to occur in approximately 10% of individuals, with jejunoileal diverticulae 3-4 times more likely to develop complications than duodenal diverticulae [ 6 ].…”

“…CT with intravenous contrast is recommended [ 1 , 16 , 17 ]. The use of oral contrast in the treatment of patients with acute abdomen, however, is debated [ 1 , 5 ].…”

“… WBC: white blood cell count; NA: not available; RUQ: right upper quadrant; RLQ: right lower quadrant; LLQ: left lower quadrant; CT: computed tomography; references: [ 4 , 5 , 7 , 8 , 10 , 16 – 21 ]. …”

Jejuno-ileal diverticulitis: A disorder not to underestimate

“…These lesions are considered as herniation of the mucosa, submucosa and serosa through the muscular layer of the bowel. Small intestine diverticula are thin-walled and usually found organized in clusters on the mesenteric border of the bowel [6]. The etiology was suggested in 1968 by Cock and Zeno, who stated that diverticula occur where the vasa recta blood vessels penetrate the mesentery area, generating a structural weakness [6,7].…”

“…Small intestine diverticula are thin-walled and usually found organized in clusters on the mesenteric border of the bowel [6]. The etiology was suggested in 1968 by Cock and Zeno, who stated that diverticula occur where the vasa recta blood vessels penetrate the mesentery area, generating a structural weakness [6,7]. Others believe that they are the result of motility disorder or ineffectiveness in contraction of the muscular intestinal wall [6].…”