Small Bowel Diverticulosis Research Articles

Intestinal Perforation Secondary to Multiple Jejunal Diverticula: Case Report

Small bowel diverticulosis is a rare condition, with an incidence ranging between 0.3% and 1.3% in the general population. Although it is typically asymptomatic, it can lead to severe complications such as perforation, diverticulitis, bleeding, and intestinal obstruction. These cases require rapid and accurate diagnostic evaluation, with computed tomography and ultrasound being essential due to the lack of established diagnostic protocols. We present the case of a 61-year-old woman with a history of colonic diverticulosis, who developed abdominal pain, fever, melena, and septic shock. Imaging revealed an intestinal perforation, confirmed by exploratory laparotomy, which identified jejunal diverticulosis with perforation. A resection of 90 cm of the small intestine was performed with a primary anastomosis. The patient recovered well in the intensive care unit. This case highlights the importance of early diagnosis and surgical intervention in small bowel diverticulosis complications, a condition that, though uncommon, can be potentially serious.

Complicated small-bowel diverticulosis and the role of Acute Care for the Elderly Unit

Small-bowel diverticulosis is a rare condition that occurs in older adults. Patients are usually asymptomatic, and some will develop complications such as gastrointestinal (GI) bleeding, intestinal obstruction, diverticulitis, and perforation. This is the case of a 95-year-old male patient with a previous history of heart failure with a preserved ejection fraction of 55%–60% and aortic stenosis since October 2019, atrial fibrillation managed with a permanent pacemaker, oral anticoagulation treatment (which was discontinued due to GI bleeding), hypertension, hypothyroidism, and chronic kidney disease. The patient presented with melena and was diagnosed with upper GI bleeding. The GI, general surgery, interventional radiology, geriatric, and palliative care teams were involved in his care. The patient received multiple blood transfusions, and upper and lower GI endoscopic and interventional radiological procedures were performed. However, owing to the patient’s functional status and age, surgery was not an option. The patient was referred to a palliative care team.

Small Bowel Diverticulosis and COVID-19: Awareness Is the Key: A Case Series and Review of the Literature.

Small bowel non-Meckelian diverticulosis is a rare condition with only a few published cases despite being described over 200 years ago. In the midst of the COVID-19 pandemic, studies suggested that many patients may experience gastrointestinal manifestations. Intestinal symptoms could worsen the inflammation and infection associated with small bowel diverticulitis. Here we present three cases: one with inflammation and rupture in a COVID-19 patient and another as an asymptomatic detection. The third case involved recurrence after the first laparoscopic lavage approach. Furthermore, we provide a mini-review of the literature to emphasize the importance of considering this entity in the differential diagnosis of an acute abdomen. In the majority of cases involving small bowel diverticula, conservative management is the preferred approach. However, when complications arise, surgical intervention, including enteroctomy and primary anastomosis, may be necessary to achieve optimal outcomes.

A rare case of entire small bowel diverticulosis- a case report

A rare case of entire small bowel diverticulosis- a case report

Bowel Perforation Due to Complicated Jejunal Diverticulitis: A Rare Case Report and Literature Review

Small bowel diverticulosis is a rare and acquired disease usually diagnosed as an incidental radiological finding. We report the case of a 65-year-old man admitted to our Emergency Department with abdominal pain and fever. The CT-scan showed multiple jejunal diverticular eversions and oedema of the surrounding tissues. At urgent laparotomy the radiological finding was confirmed with microperforation of one diverticula. Bowel resection was performed and histology revealed erosive inflammation with ischemic mucosa. Small bowel diverticula do not require any treatment if asymptomatic, nevertheless cases like this could be life-threatening. Urgent surgical procedure must be the treatment of choice in these patients.

Non-Meckel's small intestine diverticulitis presenting with obstruction and perforation

Small bowel diverticulosis (excluding Meckel's diverticulum) is a rare condition, which predominates in older adults. It is theorized that irregular intestinal contractions lead to increased segmental intraluminal pressure, favouring diverticula formation. This diverticulum may develop life threatening complications. Clinical record of a patient who attends the emergency service of an IMSS hospital in Ciudad Juárez, including clinical symptoms, imaging, surgical management and pathological anatomy. Patient presented to the emergency room with a clinical and imaging picture of intestinal obstruction. An exploratory laparotomy was performed, finding a diverticular disease of the small intestine complicated by diverticular perforation, which was confirmed by histopathological study. Due to its high morbidity and mortality, non-Meckel's diverticulitis of the small intestine is a pathology that should be considered as a differential diagnosis in adults over 70 years of age with abdominal pain.

Tics in the Small Intestine: An Unusual Case of Jejunal Diverticulitis

Small bowel (SB) diverticulosis is rare and usually has an asymptomatic presentation. Diverticular microperforations provoke inflammation and diverticulitis. Given the disease rarity, no current treatment guidelines exist. Little is known regarding malignancy-associated SB diverticulitis and screening with endoscopic procedures, capsule endoscopy, or radiographic imaging may be difficult or inadequate. In this case, we report on a 64-year-old woman who presented with abdominal pain secondary to jejunal diverticulitis, received antibiotics with radiographic disease resolution, and will undergo malignancy screening with balloon enteroscopy.

S3453 Small Bowel Diverticulosis and Malrotation: A New Spin on SIBO

S3453 Small Bowel Diverticulosis and Malrotation: A New Spin on SIBO

Multiple Jejunal Diverticulosis Complicated by Perforation: Case Report and a Brief Literature Review

Abstract Background Multiple small-bowel diverticulosis comprises a rare entity with probable underestimated incidence, and that may be the reason why it is sometimes overlooked when managing cases with peritonitis. Case report In the present paper, we report the case of a 76-year-old male presenting abdominal pain and fever in an acute setting. Computed tomography (CT) scans revealed jejunal thickening and numerous images of saccular addition that were interpreted as jejunoileal diverticulitis. After an initial period of clinical treatment, surgical management was indicated based on a worsening clinical picture and the presence of an extraluminal focus of gas detected in a subsequent CT scan. Through a laparoscopic approach, multiple small-bowel diverticula and a tamponade perforation were found. A segmental intestinal resection was performed, and the patient was discharged after a ten days. Conclusions Multiple jejunal diverticulosis is a rare condition that should be remembered in the setting of an acute abdomen. As it prevails among older patients, early diagnosis with radiological aid is crucial to establish the most adequate management, including intestinal resection, if necessary.

Case report on a rare cause of small bowel perforation perforated ileal diverticulum.

IntroductionComplications due to small bowel non-Meckel's diverticulosis is an uncommon clinical scenario encountered in clinical practice. A diverticulum in the ileum is rare among the locations of the diverticulum in the small intestine. We describe an unusual case of ileal diverticular perforation presenting as an acute abdomen.Case presentation and managementA 74-year-old male presented with septic shock and localized peritonitis in right lower abdomen. Preoperative imaging and intraoperative findings were consistent with terminal ileal diverticular perforation for which right hemicolectomy was done.ConclusionSmall bowel diverticulosis was usually asymptomatic, though it can rarely present with acute abdominal emergencies. Computed tomogram of the abdomen, Barium meal follow-through, capsule endoscopy, CT enteroclysis can be used to diagnose small bowel diverticulosis. Although the incidence of small bowel diverticulosis is low, small bowel diverticulitis should be included in the differential diagnosis if an inflammatory mass involving the small bowel is demonstrated on CT. Patients with localized and self-limited inflammation without free perforation in imaging can be treated conservatively with parenteral antibiotics and close monitoring approach. Surgical intervention is usually required for complicated acute presentations and those with refractory symptoms. A high index of suspicion of complicated small bowel diverticulosis should be in the clinician's mind when dealing with acute small bowel emergencies especially in elderly patients.

Jejunal Diverticulosis perforation: rare cause of Acute Abdomen

Introduction: Small bowel diverticulosis is a rare pathology; in contrast to colonic diverticular disease. It usually remains asymptomatic and undiscovered, until severe complications such as diverticulitis or even perforation occurs. We present a rare cause of acute abdominal pain with a case of jejunal diverticulitis complicated with perforation. Case report: We report the case of an 84-year-old woman, who was admitted to the emergency department for the management of jejunal diverticulitis with perforation, who underwent immediate surgery after confirmation on abdominal CT-scan. Conclusion: Jejunal diverticulitisis a rare entity that may lead to chronic non-specific abdominal symptoms. However, it can also present as an acute complication, one of its form being intestinal perforation, which may require immediate surgical intervention.

S1740 Lost in Space: Video Capsule out of Orbit Causing a Colo-Vaginal Fistula

INTRODUCTION: Capsule retention is a possible complication of video capsule (VC) endoscopy, occurring in approximately 2% of patients, with colonic retention making up less than 1% of cases.1 Retention may lead to further complications including obstruction and perforation.1 We present a rare case of a retained VC resulting in a colo-vaginal fistula. CASE DESCRIPTION/METHODS: A 65 year old female with a past medical history of familial cardiomyopathy and polycystic kidney disease presented for evaluation for combined cardiac and renal transplant. She had an extensive workup for iron-deficiency anemia 4 years prior to admission, which included an upper endoscopy, colonoscopy, and a VC endoscopy. She additionally reported 1-year history of postprandial abdominal bloating, 3 to 4 bowel movements daily with occasional “rosey”-tinged mucus, and occasional stool passage through the vagina. To further evaluate her symptoms, a computed tomography of abdomen and pelvis demonstrated a foreign body believed to be a retained VC(Figure 1). Barium enema was consistent with recto-vaginal fistula. Flexible sigmoidoscopy was attempted for removal of foreign body and endoscopic closure of the fistula. During the procedure, a large diverticulum with an area of congested mucosa was seen in the sigmoid colon. Contrast injection demonstrated active extravasation identifying the fistula (Figure 2). The VC was seen on fluoroscopy at the level of the fistula. Epithelialization limited foreign body removal, and closure was not attempted. General surgery was consulted, and she underwent surgical fistula takedown and sigmoid colectomy. Intraoperatively, the capsule was noted to be in a diverticulum and next to the fistula and was removed. DISCUSSION: Capsule retention is typically defined as lack of passage of a VC into the cecum for 2 weeks.2 Retention can be asymptomatic or lead to pain, bowel obstruction, and fistula formation.3,4 Abdominal imaging is necessary if there is concern for retained VC. Treatment for VC retention involves medical therapy (mainly laxatives or steroids), endoscopic retrieval, or surgery.5 In this patient, the VC was retained inside a large diverticulum, and the subsequent inflammatory response likely contributed to fistula formation. Colonic capsule retention is rare and has been associated with small bowel diverticulosis rather than colonic diverticulosis.6 Our case is a rare presentation of colo-vaginal fistula likely secondary to retained VC that has not been reported to date.Figure 1.: CT Abdomen/Pelvis image with foreign body/presumed video capsule in sigmoid colon.Figure 2.: A. Fluoroscopic image of video capsule located in diverticulum. Contrast used to determine fistulous connection from sigmoid colon to vagina. B. Fluoroscopic image of retained video capsule with recent model video capsule placed on patient for comparison.Figure 3.: References.

AB197. Jejunal diverticulosis—a rare cause life-threatening gastrointestinal bleeding

Background: Small bowel diverticulosis is a rare entity comprising of multiple outpouchings of the mesenteric border of the small bowel. The prevalence is reported at 0.2–1.3%. These pseudodiverticula are an acquired pathology of the small bowel, involving the mucosal and submucosal layers. It is hypothesised that they are pulsion diverticulae due to herniation at the site of blood vessel penetration through the bowel wall.

Small Bowel Diverticulosis: Pathogenesis, Clinical Management, and New Concepts.

Small bowel diverticulosis is a well-known clinical entity whose diagnosis and management has evolved in recent years. This review covers pathophysiology, incidence, and prevalence, and it also provides an update on modern diagnosis and management. Meckel's diverticula are covered elsewhere in this volume. CT scan and MRI have largely supplanted barium follow-through for diagnosis. No intervention is needed in asymptomatic individuals. Endoscopic management is playing an increasing role for both bleeding and resection of intraduodenal diverticula, but surgical intervention remains the only definitive intervention for other complications like diverticulitis and small bowel obstruction. Small bowel diverticulosis is an uncommon condition which is associated with numerous possible complications. While endoscopy is playing an increasingly large role in management, surgical resection remains the treatment of choice for most complications. A high index of suspicion is needed in order to diagnose this entity.

1981 A Case of Jejunal Diverticulum Causing Life-Threatening Hemorrhage

INTRODUCTION: Diverticulosis seldom causes life threatening hemorrhage and is frequently found in the large bowel. Rare cases of small bowel diverticula are most notably known to appear in the duodenum. Even rarer are severe small bowel diverticulum bleeds in the jejunum with one study noting approximately 50 cases reported in the literature. Due to the difficult location, many have gone unidentified and ultimately resulted in small bowel resections. We present a 58-year-old man with a life threatening jejunal diverticular bleed that was diagnosed and treated conservatively. CASE DESCRIPTION/METHODS: A 58-year-old Hispanic male with past medical history significant for upper GI bleed requiring multiple transfusions, chronic pancreatitis, and SMA thrombosis presented to the ED for recurrent melena. He was previously admitted for suspected GI bleed with no identifiable source on colonoscopy, EGD, and outpatient capsule endoscopy. On this admission, vitals were hemodynamically stable but labs revealed a hemoglobin of 3.3. After appropriate resuscitation, push endoscopy revealed a bleeding proximal jejunal diverticulum which was tattooed, coagulated with epinephrine and clipped. CTA of abdomen showed a stable dissecting aneurysm in between the origin of the inferior pancreaticoduodenal arcade and jejunal branches. He was stabilized and discharged with follow up. DISCUSSION: Small bowel diverticulosis is usually found incidentally in asymptomatic patients. Because jejunal diverticuli are novelty differentials, often forgotten, diagnosis becomes delayed even with the use of standard endoscopy, resulting in significant morbidity and mortality. Several noninvasive studies can be done initially to assess for bleeding. With advances in technology such as small bowel enteroscopy, specifically push enteroscopy, jejunal diverticulum can be diagnosed earlier and treated with clipping as opposed to surgical resection which has been the mainstay treatment for refractory bleeding. This case brings to light a rare manifestation of small bowel diverticuli where future research could be dedicated. There has been another case with similar presentation in which the patient also had history of a SMA clot. This poses the question of whether there is a correlation and if it could be explained by the compromised integrity of the small bowel wall due to the lack of blood flow making it easier for diverticuli to arise there. It also raises the question as to why certain patients are more predisposed to developing these outpouchings.

Small Bowel Diverticulosis Causing Pneumoperitoneum without Peritonitis: A Case Report

AbstractSmall bowel diverticulosis is a rare finding, with varied clinical presentations, which make the diagnosis difficult and delayed. Many cases are asymptomatic. However, it is an entity that can present with fatal complications. Here, we present a case of a 79-year-old male patient with diffuse small bowel diverticulosis, who presented with loose stools and acute exacerbation of chronic abdominal pain. Plain abdominal X-ray showed dilated bowel loops and pneumoperitoneum, which raised the possibility of bowel perforation. Computed tomography images revealed diffuse small bowel diverticulosis and pneumoperitoneum. Subsequent explorative laparotomy revealed no bowel perforation. Small bowel diverticulosis is a well-known cause of chronic/recurrent pneumoperitoneum without peritonitis or surgery.

Small Bowel Diverticulosis: Does Location Matter?

Small intestinal diverticulosis is characterized by the presence of multiple sac-like mucosal herniations through weak points in the intestinal wall which are far less common than colonic diverticula. Terminal ileal diverticulosis is extremely rare with a reported prevalence on conventional barium studies of 0.3-1.9%. They are most commonly observed in the duodenum (45%) followed by the jejunum (16%) and ileum (5%). We report a case of an 82 year old male with a history of hypertension, diabetes mellitus, coronary artery disease, heart failure, and cerebrovascular accident who was admitted for shortness of breath secondary to symptomatic anemia. He was found to have a microcytic anemia and dark stools with no signs of active bleeding. An esophagogastroduodenoscopy (EGD) was grossly unremarkable and biopsies revealed mild, chronic, inactive gastritis that was negative for Helicobacter pylori and intestinal metaplasia. A colonoscopy revealed severe diverticulosis throughout the entire colon as well as the terminal ileum without signs of active or recent bleeding (figure 1). Although no active bleeding was seen on ileo-colonoscopy it was presumed that the source of bleeding was either from an ileal or colonic diverticular bleed. The patient was conservatively managed and remained hemodynamically stable with no further episodes of black stools and was subsequently discharged home. Small bowel diverticulosis is a rare clinical entity. Most cases are diagnosed incidentally upon abdominal computed tomography (CT) or endoscopy. However, Gross and Katz (2003) recommend that any patient with a triad of anemia, abdominal pain, and an abdominal radiograph with dilated loops of small bowel merits small bowel diverticulosis in the differential diagnosis [4]. Furthermore, clinicians should be aware that small bowel diverticulosis can be associated with complications such as pseudo-obstruction, blind loop syndrome, dyskinesia, chronic diverticulitis, enterolith, perforation, peritonitis, bleeding, fistula formation, volvulus, and malabsorptive diarrhea [2-5]. Since gastrointestinal bleeding is a known complication of small intestinal diverticulosis, terminal ileum intubation at time of colonoscopy should always be performed especially if an upper endoscopy and colonoscopy fail to identify a source of bleeding and in the appropriate clinical context.2531 Figure 1. Diverticulosis in the terminal ileum.

Gastric volvulus through Morgagni hernia and intestinal diverticulosis in an adult patient: a case report

BackgroundMorgagni’s hernia (MH) is a rare type of congenital diaphragmatic hernia with limited available literature. Late presentations are infrequent and the ones complicated due to gastric volvulus are even rarer. Another uncommon association of MH is with small bowel diverticulosis. We herein discussed a case of gastric volvulus as the content of MH, and small bowel diverticulosis present in a patient concomitantly.Case presentationA 30 year old woman, who presented with a one year history of epigastric burning and indigestion, occasionally associated with pain and vomiting. On clinical examination, no clue to the diagnosis could be ascertained. Her chest and abdominal x-ray indicated an abnormal air-fluid level at right hemithorax, which prompted a Computed Tomography (CT) scan, showing organo-axial gastric volvulus. MH with gastric volvulus was observed during laparotomy and trans-thoracic reduction of the contents was performed, along with repair of the defect. Multiple intestinal diverticuli were also found and the largest diverticulum was excised.ConclusionsGastric volvulus through MH is a rare but potentially life-threatening condition. Non-specific symptoms like epigastric pain and vomiting can delay the diagnosis and management, however, advanced imaging techniques like CT scan can speed up this process. After the diagnosis is made, surgical repair should be attempted regardless of symptoms.

A rare case of fatal rectal bleeding from diverticular diseases of the jejunum

Diverticulosis is a condition which balloon-like sacs developing in the intestinal wall commonly in the colon. Even though diverticulosis is usually asymptomatic, rare complications are the abdominal pain, infection, perforation, bleeding and intestinal obstruction. Colonoscopy and barium enema X-ray studies can confirm the diagnosis. It is rare to find diverticulosis in the small intestine. Bleeding is usually mild because diverticulum is usually formed at the antimesenteric border. When a diverticulum develops in mesenteric border, ulceration of its mucosa can erode into mesenteric blood vessels and may lead to massive bleeding. A 54-year-old male who was suffering from diabetes mellitus, hypertension and ischemic heart diseases developed abdominal pain and bleeding perrectum. Flexible sigmoidoscopy showed inflamed patches of bowel and upper gastrointestinal endoscopy revealed gastric erosions. Rectal bleeding persisted and the patient needed a transfusion of 25 pints of blood. CT angiogram revealed bleeding focus at the region of duodeno-jejunal junction. The patient died while he was getting transferred for Digital Subtraction Angiography. Postmortem examination showed external and internal pallor, mild pulmonary oedema and three sites of U- shaped bowel adhesions in the jejunum. All three loops had small pouches which opened into the intestinal lumen. One pouch which was present at the mesenteric border of the jejunum had an ulcer eroded into mesenteric blood vessels. This case is a very rare example of jejunal diverticulosis on mesenteric border causing fatal haemorrhage. When there is a history of massive rectal bleeding, small bowel diverticulosis is also should be considered in clinical practice as well as in forensic pathology practice.

Small-bowel diverticulosis presenting as intestinal obstruction: Case report and literature review

Small-bowel diverticulosis presenting as intestinal obstruction: Case report and literature review