Small Intestinal Diverticulosis 

  • Author: Rohan C Clarke, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Mar 30, 2012
 

Background

Small intestinal diverticulosis refers to the clinical entity characterized by the presence of multiple saclike mucosal herniations through weak points in the intestinal wall.[1, 2, 3] Small intestinal diverticula are far less common than colonic diverticula. The singular form is diverticulum, and the plural form is diverticula.

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Pathophysiology

The cause of this condition is not known. It is believed to develop as the result of abnormalities in peristalsis, intestinal dyskinesis, and high segmental intraluminal pressures.

The resulting diverticula emerge on the mesenteric border, ie, sites where mesenteric vessels penetrate the small bowel. Diverticula are classified as true and false. True diverticula are composed of all layers of the intestinal wall, whereas false diverticula are formed from the herniation of the mucosal and submucosal layers. Meckel diverticulum is a true diverticulum.

Diverticula can be classified as intraluminal or extraluminal. Intraluminal diverticula and Meckel diverticulum are congenital. Extraluminal diverticula may be found in various anatomic locations and are referred to as duodenal, jejunal, ileal, or jejunoileal diverticula.

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Epidemiology

Frequency

United States

Duodenal diverticula are approximately 5 times more common than jejunoileal diverticula. The actual incidence of both types of diverticula is not known because these lesions are usually asymptomatic. The incidence at autopsy of duodenal diverticula is 6-22%. Jejunal diverticula are less common, with a reported incidence of less than 0.5% on upper gastrointestinal (GI) radiographs and a 0.3-1.3% autopsy incidence.

International

Incidence parallels that in the United States.

Mortality/Morbidity

Small bowel diverticula are generally asymptomatic, with the exception of Meckel diverticulum. Major complications include diverticulitis, GI hemorrhage, intestinal obstruction, acute perforation, and pancreatic and/or biliary disease in duodenal diverticula. Mortality is influenced by patients' age, nature of complications, and timeliness of intervention.

Race

No racial predilection exists.

Sex

Duodenal diverticula occur in equal numbers of men and women, while a slight male preponderance exists in jejunoileal diverticula.

Age

Most cases of duodenal diverticula are observed in patients older than 50 years, while jejunoileal diverticula are commonly observed in patients aged 60-70 years. Reports of this condition in young adults exist as well.

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Contributor Information and Disclosures
Author

Rohan C Clarke, MD  Consulting Staff, Department of Gastroenterology, JPS Health Systems Hospital

Rohan C Clarke, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society of Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Coauthor(s)

Rachael M Ferraro, DO  Internal Medicine Hospitalist, Torrance Memorial Medical Center, Little Company of Mary Hospital

Rachael M Ferraro, DO is a member of the following medical societies: American College of Osteopathic Internists, American College of Physicians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Lisa Ozick, MD  Former Chief, Division of Gastroenterology, Harlem Hospital Center

Lisa Ozick, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Oluyinka S Adediji, MD  Consulting Staff, Department of Adult and General Medicine, Health Services Incorporated, Montgomery, Alabama

Oluyinka S Adediji, MD is a member of the following medical societies: American College of Physicians and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

David Eric Bernstein, MD  Director of Hepatology, North Shore University Hospital; Professor of Clinical Medicine, Albert Einstein College of Medicine

David Eric Bernstein, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Douglas M Heuman, MD, FACP, FACG, AGAF  Chief of GI, Hepatology, and Nutrition at North Shore University Hospital/Long Island Jewish Medical Center; Professor, Department of Medicine, Hofstra North Shore-LIJ School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, and American Gastroenterological Association

Disclosure: Novartis Grant/research funds Other; Bayer Grant/research funds Other; Otsuka Grant/research funds None; Bristol Myers Squibb Grant/research funds Other; Scynexis None None; Salix Grant/research funds Other; MannKind Other

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

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  2. Isselbacher KJ, Ebstein A. Diverticular, vascular and other disorders of the intestine and peritoneum. In: Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill Inc; 1998:1648-9.

  3. Mark B. Small intestine. In: Seymour I, Schwartz G, eds. Principles of Surgery. New York: McGraw-Hill Inc; 1999:1247-9.

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  8. Carey EJ, Fleischer DE. Investigation of the small bowel in gastrointestinal bleeding--enteroscopy and capsule endoscopy. Gastroenterol Clin North Am. Dec 2005;34(4):719-34. [Medline].

  9. Dietrich CF, Braden B. Sonographic assessments of gastrointestinal and biliary functions. Best Pract Res Clin Gastroenterol. 2009;23(3):353-67. [Medline].

  10. Donald JW. Major complications of small bowel diverticula. Ann Surg. Aug 1979;190(2):183-8. [Medline].

  11. Eckhauser FE, Zelenock GB, Freier DT. Acute complications of jejuno-ileal pseudodiverticulosis: surgical implications and management. Am J Surg. Aug 1979;138(2):320-3. [Medline].

  12. Hartmann D, Schmidt H, Bolz G. A prospective two-center study comparing wireless capsule endoscopy with intraoperative enteroscopy in patients with obscure GI bleeding. Gastrointest Endosc. Jun 2005;61(7):826-32. [Medline].

  13. Rubesin SE. Simplified approach to differential diagnosis of small bowel abnormalities. Radiol Clin North Am. Mar 2003;41(2):343-64, vii. [Medline].

  14. Sanford JP, Gilbert DN, Moellering RC. The Sanford Guide to Antimicrobial Therapy 1999. Sperryville, Va: Antimicrobial Therapy, Inc; 1999:02-1333. [Full Text].

 
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