Imaging Sciences Interesting Cases
Case 113
Trushar Sarang, MD
Clinical Presentation: A 49-year-old male presented with a history of gastrointestinal bleeding.
Imaging Findings: Multiple sac-like outpouchings arising from the small bowel.
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| Figures 1A-C: Enteroclysis examination demonstrates multiple sac-like outpouchings arising from the small bowel. They are distributed predominantly in the duodenum, however, multiple diverticula are seen in the jejunum and ileum. |
Diagnosis: Small bowel diverticulosis
Discussion: Small bowel diverticulosis is usually found incidentally during imaging. Diverticula can occur anywhere along the small bowel, but most frequently affects the duodenum. The diverticula generally arise on the mesenteric border of the bowel where the mesenteric vessel insertion produces an effective weak spot in the bowel musculature. Clinical symptoms are rare, but when they do occur, they are usually a result of bacterial overgrowth due to stasis within the diverticula. Fat malabsorption may occur due to bile acid deconjugation. B12 deficiency and resultant macrocytic anemia may also occur. Rarely, this condition may present acutely with intestinal bleeding, as seen in this case. Other rarer presentations include diverticulitis, perforation, volvulus, or obstruction.
Because this is an asymptomatic condition, the exact incidence of small bowel diverticulosis is difficult to ascertain, however, it is estimated at approximately 0.3-2.5%. There is a slight male predilection and the average age of presentation is between 50-70 years old. Duodenal diverticula are associated with biliary stones, pancreatitis and biliary abnormalities. Jejunal/ileal diverticula are associated with motility disorders, such as scleroderma and visceral neuropathies.
Surgery is recommended for symptomatic lesions, however, when diverticula are diffuse, it must be determined if the benefits of resection outweighs the risk of short gut syndrome.
References:
- de Lange DW, Cluysenaer OJ, Verberne GH, van de Wiel A. [Diverticulosis of the small bowel]. Ned Tijdschr Geneeskd. 2000 May 13;144(20):946-9. [PubMed]
- Rodriguez HE, Ziauddin MF, Quiros ED, Brown AM, Podbielski FJ. Jejunal diverticulosis and gastrointestinal bleeding. JJ Clin Gastroenterol. 2001 Nov-Dec;33(5):412-4. [PubMed]
- Johnson CD, Schmit GD. Mayo Clinic Gastrointestinal Imaging Review. Mayo Clinic Scientific Press, 2005.