GI Radiography

Imaging Diagnosis:

Giant small bowel diverticulum

Discussion:

Primary acquired jejunoileal diverticulosis is an unusual entity. The diverticula are classified as false diverticula and result from herniation of mucosa and submucosa through the muscular layer of the bowel wall. The diverticula usually occur at the mesenteric border of the bowel and can vary in size from a few millimeters to >10 cm.

Small-bowel motor dysfunction has been postulated as an etiology, and the entity has been associated with abnormalities, such as scleroderma, involving a myopathic or neuropathic abnormality. It has been proposed that disordered contractions of the abnormal portion of the small bowel secondary to motor dysfunction of the smooth muscle or myenteric plexus causes increased intraluminal pressure. This results in herniation of mucosa and submucosa through the weakest part of the bowel wall at the site of penetration of mesenteric paired blood vessels.

Patients are usually elderly, in the seventh decade and above. Most cases are asymptomatic. However, jejunoileal diverticulosis can be the cause of vague, chronic symptoms as in the case shown here. Most patients can be managed medically. However, the disorder may be associated with enterolith ileus, bacterial overgrowth, and malabsorption and can also result in other serious complications including severe inflammation, abcess, hemorrhage, and perforation. Computed tomography may be helpful in diagnosing and defining the extent of related complications.

Dr. Nikhil Cunha, Mumbai