Small Bowel Diverticulosis: Pathogenesis, Clinical Management, and New Concepts
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Published on: July 12, 2018
Vikram Rangan1, J Thomas Lamont2
1Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA. vrangan@bidmc.harvard.edu.
Purpose Of Review:
Small bowel diverticulosis is a well-known clinical entity whose diagnosis and management has evolved in recent years. This review covers pathophysiology, incidence, and prevalence, and it also provides an update on modern diagnosis and management. Meckel's diverticula are covered elsewhere in this volume.
Recent Findings:
CT scan and MRI have largely supplanted barium follow-through for diagnosis. No intervention is needed in asymptomatic individuals. Endoscopic management is playing an increasing role for both bleeding and resection of intraduodenal diverticula, but surgical intervention remains the only definitive intervention for other complications like diverticulitis and small bowel obstruction. Small bowel diverticulosis is an uncommon condition which is associated with numerous possible complications. While endoscopy is playing an increasingly large role in management, surgical resection remains the treatment of choice for most complications. A high index of suspicion is needed in order to diagnose this entity.
Insights
Small bowel diverticulosis diagnosis has advanced with CT and MRI replacing barium studies. While asymptomatic cases require no intervention, endoscopy and surgery manage complications like bleeding and obstruction.
Area of Science:
- Gastroenterology
- Digestive Diseases
Background:
- Small bowel diverticulosis is a recognized condition with evolving diagnostic and management strategies.
- This review focuses on the pathophysiology, incidence, prevalence, and modern approaches to small bowel diverticulosis, excluding Meckel's diverticula.
Purpose of the Study:
- To provide an updated review of small bowel diverticulosis.
- To cover pathophysiology, incidence, prevalence, diagnosis, and management.
Main Methods:
- Review of current literature on small bowel diverticulosis.
- Focus on diagnostic imaging and therapeutic interventions.
Main Results:
- Computed tomography (CT) scans and magnetic resonance imaging (MRI) are now preferred over barium follow-through for diagnosis.
- Asymptomatic small bowel diverticulosis typically requires no intervention.
- Endoscopic management is increasingly utilized for bleeding and intraduodenal diverticula resection.
- Surgical intervention remains the primary treatment for complications such as diverticulitis and small bowel obstruction.
Conclusions:
- Small bowel diverticulosis is uncommon but can lead to serious complications.
- A high index of suspicion is crucial for timely diagnosis.
- While endoscopy plays a growing role, surgical resection is the definitive treatment for most complications.
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