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Diverticula of the Small Intestine
A diverticulum of the small bowel is a “blind” outpocket from the hollow viscus that consists of one or more layers ( Fig. 57.1 ). Incidence at autopsy ranges from 0.2% to 0.6%. Diverticula are less common in distal areas of the small bowel. Their etiology is unknown, but most appear to be acquired and to consist of mucosal and submucosal layers only. Colonic diverticulosis is associated with small bowel diverticulosis in 35% to 44% of patients. Complications of inflammation and diverticulitis, obstruction associated with enteroliths, bleeding, perforation, volvulus, bacterial overgrowth, and multiple diverticula have all been reported.
Diverticula of the Small Intestine.
Clinical Picture
The clinical picture may be an incidental finding and asymptomatic, an acute complication, or chronic symptoms. Symptoms of acute abdomen caused by free perforation, volvulus, or obstruction associated with an enterolith or gastrointestinal (GI) bleeding may cause a patient to seek treatment. Chronic presenting symptoms, including dyspepsia, nausea, occasional vomiting, mild pain, flatulence, and diarrhea, may be caused by bacterial overgrowth or mild inflammation associated with one of the diverticula. Therefore, a broad presenting clinical picture is possible.
Once diagnosed, symptoms should be fully evaluated. Clinicians tend to view diverticula as benign, but they can be a significant finding. Once inflammation occurs in a diverticulum, an acute abdominal infection can result that mimics appendicitis or inflammation, as in Meckel diverticulum. When inflammation develops, erosion of a blood vessel can cause a slow bleed or a massive hemorrhage.
The clinicopathologic correlation of jejunal diverticula is similar to that seen in colonic diverticulosis. The association of jejunal diverticula with steatorrhea and macrocytic anemia has been reported since 1954. There are many cases in the literature of proven bacterial overgrowth and malabsorption. Many patients with jejunal diverticula also have symptoms similar to those of scleroderma, such as esophageal motility disturbances and Raynaud phenomenon.
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