Small Intestine Diverticula

• • Most jejunoileal diverticula are acquired true diverticula

  • -Meckel diverticulum is congenital

  • May be asymptomatic or associated with obstruction, bleeding, or inflammation (diverticulitis)

Epidemiology

• • Acquired diverticula in 1.3% of the population

  • Most contain all layers of the intestinal wall (true diverticula)

  • Often multiple, they diminish in frequency from the ligament of Treitz to the ileocecal valve

  • Meckel diverticulum is a congenital, true diverticulum that results from persistence of the vitelline duct and occurs on the antimesenteric border of the ileum

  • Heterotrophic gastric or pancreatic tissue may be present in the diverticulum

  • Follow the rule of 2:

  • -Occur in males twice as often as females

    -Occur in 2% of the population

    -Become symptomatic in 2% of cases

    -Occur 2 ft proximal to the ileocecal valve

    -May extend over 2 inches in length

    -Can cause 2 symptoms: Bleeding and obstruction

Symptoms and Signs

• • Most are asymptomatic

  • Symptoms may be due to obstruction, inflammation, bleeding, or bacterial overgrowth

  • Abdominal pain

  • GI hemorrhage

  • Diarrhea and malabsorption

Laboratory Findings

• • Elevated WBC count (inflammation)

  • Anemia (bleeding)

Imaging Findings

• • Upper GI contrast radiography: May outline the diverticula and any associated obstruction

  • CT scan: May reveal the diverticula as well as associated inflammation or obstruction

  • Meckel diverticulum: 99technetium-pertechnate scan can identify ectopic gastric mucosa in the diverticulum

• • Jejunoileal diverticula may be associated with disturbed motility

  • Blind loop syndrome is caused by chronic partial obstruction or bacterial overgrowth in large diverticula

  • Obstruction in Meckel diverticulum may be due to volvulus around a persistent omphalomesenteric band or intussusception

  • Bleeding in Meckel diverticulum is due to ulceration from acid secreted by heterotopic gastric mucosa

Rule Out

• • Other causes of GI bleeding, small bowel obstruction, or small bowel inflammation

• • Upper GI contrast radiography or CT scan

  • 99Technetium-pertechnate scan in suspected cases of Meckel diverticulum

When to Admit

• • Complications

  • -Obstruction

    -Bleeding

    -Inflammation

• • Asymptomatic diverticula require no treatment

Surgery

• • Small bowel resection and anastomosis required for complications

Indications

• • Inflammation (diverticulitis)

  • Bleeding

  • Obstruction

  • Perforation

Complications

• • Inflammation (diverticulitis)

  • Perforation

  • Bleeding

  • Obstruction

Prognosis

• • Diverticula are treated completely by segmental small bowel resection

References