Small Bowel Diverticulosis

Small bowel diverticulosis is the presence of acquired pseudodiverticula, most commonly involving the jejunum and less commonly the ileum.

Unlike Meckel diverticulum, acquired jejunal diverticula lack the full muscular bowel wall and arise predominantly along the mesenteric border where blood vessels penetrate the muscularis.

They are associated with abnormal intestinal motility and elevated intraluminal pressure.

Most are asymptomatic.

Complications include bacterial overgrowth, malabsorption, bleeding, diverticulitis, perforation and obstruction from adhesions, enteroliths or volvulus.

Most patients have no symptoms.

Symptomatic disease may cause chronic postprandial discomfort, bloating or altered bowel habit.

Bacterial overgrowth can produce diarrhoea, weight loss, vitamin B12 deficiency and malabsorption.

Acute focal pain with fever suggests diverticulitis. Peritonism suggests perforation.

CT enterography: demonstrate multiple mesenteric border diverticula and identify inflammatory complications.

The diagnosis may also be made incidentally during surgery or other small bowel imaging.

Asymptomatic diverticulosis requires no surgery.

Do not prophylactically resect long segments of diverticula because unnecessary small bowel loss creates more harm than the asymptomatic condition.

Treat bacterial overgrowth when clinically evident. A commonly used option is:

Rifaximin 550 mg orally three times daily for 10 to 14 days.

Recurrence is common because antibiotics do not correct the underlying motility disorder. Alternative regimens depend on local antimicrobial practice and individual tolerance.

Operate for perforation, uncontrolled bleeding, obstruction or recurrent severe localised complications.

When surgery is required, perform limited segmental resection of the pathological bowel rather than extensive prophylactic resection of all diverticula.