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European Radiology

, Volume 26, Issue 9, pp 2881–2891 | Cite as

Magnetic resonance enterography/enteroclysis in acquired small bowel diverticulitis and small bowel diverticulosis

  • Bahar Mansoori
  • Conor P. Delaney
  • Joseph E. Willis
  • Raj M. Paspulati
  • Pablo R. Ros
  • Christine Schmid-Tannwald
  • Karin A. HerrmannEmail author
Magnetic Resonance

Abstract

Purpose

Small bowel (SB) diverticulosis is a rare disorder that may entail serious complications, including SB diverticulitis. Both are often missed in imaging. Magnetic resonance enterography/enteroclysis (MRE) is increasingly used to assess SB disease; awareness of the appearance of SB diverticulitis is essential to ensure appropriate management. Our aim was to systematically describe imaging characteristics of SB diverticulosis and diverticulitis in MRE.

Methods

This retrospective, HIPAA-compliant study identified 186 patients with suspected SB diverticulosis/diverticulitis in medical databases of two tertiary medical centres between 2005 and 2011. Patients with surgically confirmed diagnoses of SB diverticulosis/diverticulitis were included. Two observers analyzed MR images for the presence, location, number, and size of diverticula, wall thickness, and mural and extramural patterns of inflammation.

Results

Seven patients were recruited. MRI analysis showed multiple diverticula in all (100 %). Diverticular size ranged from 0.5 to 6 cm. Prevalence of diverticula was higher in the proximal than the distal SB (jejunum 86 %, ileum 57 %, distal ileum43%). Diverticulitis occurred in 3/7 patients (43 %) showing asymmetric bowel wall thickening and focal mesenteric inflammation.

Conclusion

SB diverticulitis demonstrates characteristic MRE imaging features to distinguish this rare disorder from more common diseases. Asymmetric, focal mesenteric and mural inflammation and presence of multiple diverticula are keys to diagnosis.

Key points

Small bowel diverticulosis and diverticulitis is rare and often missed in imaging

Acquired small bowel diverticula are variable in size and number

Small bowel diverticulitis demonstrates characteristic features on MR enterography/enteroclysis

A focal or segmental asymmetric small bowel inflammation should prompt the search for diverticula

Keywords

Small bowel disease Diverticulitis MR enterography MR enteroclysis Inflammatory bowel disease 

Notes

Acknowledgments

The scientific guarantor of this publication is Karin Herrmann. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was not required for this study because the study was a retrospective chart review. Methodology:retrospective, diagnostic or prognostic study, multicentre study.

References

  1. 1.
    Surov A, Stock K (2005) Jejunal diverticulosis. Eur J Med Res 10:358–360PubMedGoogle Scholar
  2. 2.
    Coulier B, Maldague P, Bourgeois A, Broze B (2007) Diverticulitis of the small bowel: CT diagnosis. Abdom Imaging 32:228–233CrossRefPubMedGoogle Scholar
  3. 3.
    Kouraklis G, Glinavou A, Mantas D, Kouskos E, Karatzas G (2002) Clinical implications of small bowel diverticula. Isr Med Assoc J 4:431–433PubMedGoogle Scholar
  4. 4.
    Olson DE, Kim YW, Donnelly LF (2009) CT findings in children with Meckel diverticulum. Pediatr Radiol 39:659–663CrossRefPubMedGoogle Scholar
  5. 5.
    De Peuter B, Box I, Vanheste R, Dymarkowski S (2009) Small-bowel diverticulosis: imaging findings and review of three cases. Gastroenterol Res Pract doi: 10.1155/2009/549853
  6. 6.
    Palder SB, Frey CB (1988) Jejunal diverticulosis. Arch Surg 123:889–894CrossRefPubMedGoogle Scholar
  7. 7.
    Chan KW (2009) Perforation of Meckel’s diverticulum caused by a chicken bone: a case report. J Med Case Rep 3:48CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Mantas D, Kykalos S, Patsouras D, Kouraklis G (2011) Small intestine diverticula: is there anything new? World J Gastrointest Surg 3:49–53CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Jerger Z, Endlicher E, Kullmann F (2008) Bleeding Jejunal Diverticulosis in a patient with Myasthenia Gravis. Diagnostic and Therapeutic Endoscopy. doi: 10.1155/2008/156496
  10. 10.
    Macari M, Faust M, Liang H, Pachter HL (2007) CT of jejunal diverticulitis: imaging findings, differential diagnosis, and clinical management. Clin Radiol 62:73–77CrossRefPubMedGoogle Scholar
  11. 11.
    Amzallag-Bellenger E, Oudjit A, Ruiz A, Cadiot G, Soyer PA, Hoeffel CC (2012) Effectiveness of MR enterography for the assessment of small-bowel diseases beyond Crohn disease. Radiographics 32(5):1423–44CrossRefPubMedGoogle Scholar
  12. 12.
    Donald JW (1979) Major complications of small bowel diverticula. Ann Surg 190:183–188CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Greenstein S, Jones B, Fishman EK, Cameron JL, Siegelman SS (1986) Small-bowel diverticulitis: CT findings. AJR Am J Roentgenol 147:271–274CrossRefPubMedGoogle Scholar
  14. 14.
    Hibbeln JF, Gorodetsky AA, Wilbur AC (1995) Perforated jejuna diverticulum: CT diagnosis. Abdom Imaging 20:29–30CrossRefPubMedGoogle Scholar
  15. 15.
    Gayer G, Zissin R, Apter S, Shemesh E, Heldenberg E (1999) Acute diverticulitis of the small bowel: CT findings. Abdom Imaging 24:452CrossRefPubMedGoogle Scholar
  16. 16.
    Lempinen M, Salmela K, Kemppainen E (2004) Jejunal diverticulosis: a potentially dangerous entity. Scand J Gastroenterol 39:905CrossRefPubMedGoogle Scholar
  17. 17.
    Ferstl FJ, Obert R (2004) CT findings in acute small bowel diverticulitis. Röfo 176:246–251PubMedGoogle Scholar
  18. 18.
    Chugay P, Choi J, Dong XD (2010) Jejunal diverticular disease complicated by enteroliths: report of two different presentations. World J Gastrointest Surg 2:26–29CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Ming TY, Feng HK, Cherng YJ, Chuan CD, Pai LT, Chi LY (2012) Clinical challenge: diverticulitis of third and fourth portion of the duodenum with perforation. Rev Esp Enferm Dig 104:156–157CrossRefPubMedGoogle Scholar
  20. 20.
    Ferreira-Aparicio FE, Gutiérrez-Vega R, Gálvez-Molina Y, Ontiveros-Nevares P, Athie-Gútierrez C, Montalvo-Javé EE (2012) Diverticular disease of the small bowel. Case Rep Gastroenterol 6:668–676CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Singal R, Gupta S, Airon A (2012) Giant and multiple jejunal diverticula presenting as peritonitis a significant challenging disorder. J Med Life 5(3):308–310PubMedPubMedCentralGoogle Scholar
  22. 22.
    Mukherjee K, Rinker EB, Kressin MK, Tarpley JL, Muldoon RL (2013) Small bowel diverticulitis masquerading as Crohn’s disease. Am Surg 79:E246–248PubMedGoogle Scholar
  23. 23.
    Monteiro R, Schneble E, Mino J, Stallion A (2013) Antimesentericjejunal diverticulosis after a remote history of necrotizing enterocolitis: a case report. BMJ Case Rep. doi: 10.1136/bcr-2013-009335 Google Scholar
  24. 24.
    Corcelles R, Pavel M, Lacy A (2014) Perforated small boweldiverticulitis after gastric bypass. JSLS 18:142–145CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Akhrass R, Yaffe MB, Fischer C (1997) Small-bowel diverticulosis: perceptions and reality. J Am Coll Surg 184:383–388PubMedGoogle Scholar
  26. 26.
    Eckhauser FE, Zelenock GB, Freier DT (1979) Acute complications of jejuno-ileal pseudodiverticulosis: surgical implications and management. Am J Surg 138:320–323CrossRefPubMedGoogle Scholar
  27. 27.
    Salomonowitz E, Wittich G, Hajek P, Jantsch H, Czembirek H (1983) Detection of intestinal diverticula by double-contrast small bowel enema: differentiation from other intestinal diverticula. Gastrointest Radiol 8:271–278CrossRefPubMedGoogle Scholar
  28. 28.
    Longo WE, Vernava AM (1992) Clinical implications of jejunoileal diverticular disease. Dis Colon Rectum 35:381–388CrossRefPubMedGoogle Scholar
  29. 29.
    Tsiotos GG, Farnell MB, Ilstrup DM (1994) Nonmeckelianjejunal or ileal diverticulosis: an analysis of 112 cases. Surgery 116:726PubMedGoogle Scholar
  30. 30.
    Chendrasekhar A, Timberlake GA (1995) Perforated jejunal diverticula: an analysis of reported cases. Am Surg 61:984PubMedGoogle Scholar
  31. 31.
    Huguenin A, Tirveilliot F, Dell’Erba U, Fabre S, Triboulet JP, Durand F (1999) Acquired jejunal and ileal diverticula (Meckel’s excluded). Ann Chir 53:522–526PubMedGoogle Scholar
  32. 32.
    Chiu EJ, Shyr YM, Su CH, Wu CW, Lui WY (2000) Diverticular disease of the small bowel. Hepatogastroenterology 47:181–184PubMedGoogle Scholar
  33. 33.
    Liu C-Y, Chang W-H, Lin S-C, Chu C-H, Wang T-E, Shih S-C (2005) Analysis of clinical manifestations of symptomatic acquired jejunoileal diverticular disease. World J Gastroenterol 11:5557–5560CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Spasojevic M, Naesgaard JM, Ignjatovic D (2012) Perforated midgut diverticulitis: revisited. World J Gastroenterol 18:4714–4720CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Woods K, Williams E, Melvin W, Sharp K (2008) Acquired jejunoileal diverticulosis and its complications: a review of the literature. Am Surg 74:849–854PubMedGoogle Scholar
  36. 36.
    Makris K, Tsiotos GG, Stafyla V, Sakorafas GH (2009) Small intestinal nonmeckelian diverticulosis. J Clin Gastroenterol 43:201–207CrossRefPubMedGoogle Scholar
  37. 37.
    Bach AG, Lübbert C, Behrmann C, Surov A (2011) Small bowel diverticula – diagnosis and complications. Dtsch Med Wochenschr 136:140–144CrossRefPubMedGoogle Scholar
  38. 38.
    Fintelmann F, Levine MS, Rubesin SE (2008) Jejunal diverticulosis: findings on CT in 28 patients. AJR Am J Roentgenol 190:1286–1290CrossRefPubMedGoogle Scholar
  39. 39.
    Chalian M, Ozturk A, Oliva-Hemker M, Pryde S, Huisman TA (2011) MR enterography findings of inflammatory bowel disease in pediatric patients. AJR Am J Roentgenol 196:W810–816CrossRefPubMedGoogle Scholar
  40. 40.
    Rimola J, Ordás I, Rodriguez S, García-Bosch O, Aceituno M, Llach J et al (2011) Magnetic resonance imaging for evaluation of Crohn’s disease: validation of parameters of severity and quantitative index of activity. Inflamm Bowel Dis 17:1759–1768CrossRefPubMedGoogle Scholar
  41. 41.
    Maccioni F, Viscido A, Broglia L, Marrollo M, Masciangelo R, Caprilli R et al (2000) Evaluation of Crohn disease activity with magnetic resonance imaging. Abdom Imaging 25:219–228CrossRefPubMedGoogle Scholar
  42. 42.
    Sinha R, Verma R, Verma S, Rajesh A (2011) MR enterography of Crohn disease: part 2, imaging and pathologic findings. AJR Am J Roentgenol 197:80–85CrossRefPubMedGoogle Scholar
  43. 43.
    Masselli G, Polettini E, Casciani E, Bertini L, Vecchioli A, Gualdi G (2009) Small-bowel neoplasms: prospective evaluation of MR enteroclysis. Radiology 251:743–750CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Bahar Mansoori
    • 1
  • Conor P. Delaney
    • 3
  • Joseph E. Willis
    • 4
  • Raj M. Paspulati
    • 1
    • 2
  • Pablo R. Ros
    • 1
    • 2
  • Christine Schmid-Tannwald
    • 5
  • Karin A. Herrmann
    • 1
    • 2
    • 6
    Email author
  1. 1.Department of RadiologyUniversity Hospitals Case Medical CenterClevelandUSA
  2. 2.Department of RadiologyCase Western Reserve UniversityClevelandUSA
  3. 3.Department of Surgery, Division of Colorectal SurgeryUniversity Hospitals Case Medical CenterClevelandUSA
  4. 4.Department of PathologyUniversity Hospitals Case Medical CenterClevelandUSA
  5. 5.Department of RadiologyUniversity Hospitals MunichMunichGermany
  6. 6.University Hospitals Case Medical CenterCase Western Reserve UniversityClevelandUSA

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