Jejunal/ileal diverticula

Epidemiology

• Less common than duodenal diverticula - incidence 0.1-1.4% in autopsy series
• Mainly occur in >50yo

Pathophysiology

• Jejunal more common and larger than ileal
• Commonly multiple
• False diverticula protruding from mesenteric border, embedded within mesentery
• Thought to develop due to motor dysfunction of the smooth muscle or the myenteric plexus, resulting in disordered contractions, generating increased intra-luminal pressure and herniation of the mucosa and submucosa through the weakest portion of the bowel (i.e. the mesenteric side)

Presentation

• Usually found incidentally at laparotomy or on imaging
• Great majority remain asymptomatic
• Chronic symptoms can occur
  • Vague chronic abdominal pain
  • Malabsorption
  • Functional pseudo-obstruction
  • Chronic low-grade bleed
• Acute complications are all rare
  • Bleeding
  • Obstruction
  • Perforation
  • Diverticulitis without abscess or perforation
  • Blind loop syndrome - can lead to megaloblastic anaemia due to uptake of B12 by bacterial flora

Management

• Asymptomatic - no treatment
• Obstruction, bleeding or perforation - resection with end-to-end anastomosis
• Malabsorption and blind loop syndrome - antibiotics in most cases
• Distal obstruction secondary to enterolith - either milk enterolith into caecum, or enterotomy and removal of enterolith
• Obstruction from enterolith at level of diverticula - bowel resection