Skip to main content

Small bowel diverticulosis: An overlooked entity

Opinion statement

Small bowel diverticulosis (SBD) is a rare entity. Most cases of diverticulosis are asymptomatic. SBD is often discovered incidentally during contrast studies and endoscopy. When patients report chronic gastrointestinal symptoms such as abdominal pain, bloating, flatulence, and anemia, SBD is often an overlooked diagnosis. Patients requiring treatment for SBD are those with complications such as malabsorption, hemorrhage, obstruction, and acute inflammation with abscess or rarely perforation. Malabsorption can be managed with broad-spectrum antibiotics and vitamin supplementation. Hemorrhage is treated conservatively with resuscitation efforts, but recurrent bleeding requires surgery. Enteroliths causing obstruction in the duodenum can be relieved by endoscopy, that is, by manipulation, but jejunoileal obstruction requires a resection. Pseudoobstruction may be managed with prokinetics such as metoclopramide, erythromycin, and the 5-hydroxytryptamine 4 agonist tegaserod. Uncomplicated cases of SBD are treated with bowel rest and antibiotics. However, perforation or abscess formation not amenable to percutaneous drainage mandates surgical resection. Any patient with a triad of anemia, abdominal pain, and an abdominal radiograph with dilated loops of small bowel merits SBD in the differential diagnosis.

This is a preview of subscription content, access via your institution.

References and Recommended Reading

  1. Longo WE, Vernarva AM: Clinical implications of jejunoileal diverticular disease. Dis Colon Rectum 1992, 35:381–388.

    PubMed  Article  CAS  Google Scholar 

  2. Kouraklis G, Mantas D, Glivanou A, et al.: Diverticular disease of the small bowel: report of 27 cases. Int Surg 2001, 86:235–239. A recent retrospective review of 27 patients with SBD, focusing on the management of SBD complications.

    PubMed  CAS  Google Scholar 

  3. Chiu EJ, Shyr YM, Su CH, Wu CW, et al.: Diverticular disease of the small bowel. Hepatogastroenterology 2000, 47:181–184. A retrospective review of patients with SBD. The article discusses clinical presenation, diagnostic tests, and management options for patients with SBD.

    PubMed  CAS  Google Scholar 

  4. Akharass R, Yaffe MB, Fischer C, et al.: Small bowel diverticulosis: perceptions and reality. 1997; 184:383–388.

  5. Kourikalis G, Glinavou A, Mantas D, et al.: Clinical implications of small bowel diverticula. Isr Med Assoc J 2002, 4:431–433. A retrospective review study of SBD. A well-summarized article for clinicians.

    Google Scholar 

  6. Wu NH, Wang HP, Yang CS, et al.: Endoscopic hemoclip therapy of a bleeding duodenal diverticulum. Gastrointest Endosc 2000, 51:489–491.

    PubMed  Article  CAS  Google Scholar 

  7. Maluf-Filho, Lopasso FP, Matuguma SE, et al.: Endosonographic diagnosis of intraluminal diverticulum. Endoscopy 1998, 30:496–498.

    PubMed  CAS  Google Scholar 

  8. Mehidi A, Closset J, Houben G, et al.: Duodenal diverticula —diagnosis and management of complicated forms: report of two clinical cases and review of the literature. Acta Chir Belg 1994, 94:311–313.

    Google Scholar 

  9. Krishnamurthy S, Kelly MM, Rohrmann CA, et al.: Jejunal diverticulosis: a heterogeneous disorder caused by a variety abnormalities of smooth muscle or myenteric plexus. Gastroenterology 1983, 85:538–547.

    PubMed  CAS  Google Scholar 

  10. Maglinte DDT, Chernish SM, DeWeese R, et al.: Acquired jejunoilieal diverticular disease: subject review. Radiology 1986, 158:577–580.

    PubMed  CAS  Google Scholar 

  11. Chow DC, Babaian M, Taubin HL: Jejunal diverticula. Gastroenterologist 1997, 5:78–84.

    PubMed  CAS  Google Scholar 

  12. Harris LM, Volpe CM, Doerr RJ: Small bowel obstruction secondary to enterolith impaction complicating jejunal diverticulitis. Am J Gastroenterol 1997, 92:1538–1540.

    PubMed  CAS  Google Scholar 

  13. Kavita R, Kongara KR, Soffer EE: Intestinal motility in small bowel diverticulosis. J Clin Gastroenterol 2000, 30:84–86. Focuses on the pathophysiology of SBD.

    Article  Google Scholar 

  14. Davis GE: Multiple small bowel diverticula. J Maine Med Assoc 1977, 68:79–81.

    PubMed  CAS  Google Scholar 

  15. Karoll MP, Ghahremani GG, Port RB, et al.: Diagnosis and management of intraluminal duodenal diverticulum. Dig Dis Sci 1983, 28:411–416

    PubMed  Article  CAS  Google Scholar 

  16. Cools P, Bosmans E, Onsea J, et al.: Small bowel diverticulosis. A forgotten diagnosis. Acta Chir Belg 1995, 95:261–264.

    PubMed  CAS  Google Scholar 

  17. de Bree E, Grammatikakis J, Christodoulakis M, et al.: The clinical significance of acquired jejunoileal diverticula. Am J Gastroenterol 1998, 93:2523–2528.

    PubMed  Article  Google Scholar 

  18. Finnie IA, Ghosh P, Garvey C, et al.: Intraluminal duodenal diverticulum causing recurrent pancreatitis: treatment by endoscopic incision. Gut 1994, 35:557–559.

    PubMed  CAS  Google Scholar 

  19. Ziauddin MF, Quiros ED, Brown AM, et al.: Jejunal diverticulosis and gastrointestinal bleeding. J Clin Gastroenterol 2001, 33:412–414.

    PubMed  Article  Google Scholar 

  20. Sibille A, Willocx R: Jejunal diverticulitis. Am J Gastroenterol 1992, 87:655–658.

    PubMed  CAS  Google Scholar 

  21. Khandelwal M, Akerman PA, Jones WF, et al.: Endoscopic therapy for a bleeding duodenal diverticulum. Am J Gastroenterol 1995, 90:1328–1329.

    PubMed  CAS  Google Scholar 

  22. Dalal AA, Rogers SJ, Cello JP: Endoscopic management of hemorrhage from duodenal diverticulum. Gastrointest Endosc 1998, 48:418–420.

    PubMed  Article  CAS  Google Scholar 

  23. Jeyarajah R, Harford W: Diverticula of the hypopharynx, esophagus, stomach, jejunum, and ileum. In Sleisenger & Fordtran’s Gastrointestinal and Liver Disease, edn 7. Edited by Feldman M, Friedman LS, Sleisenger MH. Philadelphia: WB Saunders; 2002:364–368.

    Google Scholar 

  24. Van Os EC, Petersen BT, Kelly DG, et al.: Endoscopic management of intraluminal duodenal diverticulum. Gastrointest Endosc 1996, 44:494–497.

    PubMed  Article  Google Scholar 

  25. Palder SB, Frey CB: Jejunal diverticulosis. Arch Surg 1988, 123:889–894.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Gross, S.A., Katz, S. Small bowel diverticulosis: An overlooked entity. Curr Treat Options Gastro 6, 3–11 (2003). https://doi.org/10.1007/s11938-003-0027-4

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11938-003-0027-4

Keywords

  • Diverticulitis
  • Diverticular Disease
  • Main Side Effect
  • Main Drug Interaction
  • Tegaserod