Small bowel diverticulosis: imaging appearances, complications, and pitfalls

Area of Science:

• Gastroenterology
• Radiology
• Abdominal Imaging

Background:

• Small bowel diverticula (SBD) are classified as true (e.g., Meckel's) or false.
• False SBD result from herniation through the bowel wall's muscularis propria.
• Distal SBD in the jejunum and ileum are underappreciated and under-reported on cross-sectional imaging.

Purpose of the Study:

• To review the imaging characteristics of small bowel diverticula (SBD).
• To improve radiologist confidence in diagnosing SBD and their complications on cross-sectional imaging.
• To highlight SBD as a cause of benign pneumoperitoneum and discuss diagnostic pitfalls.

Main Methods:

• Review of multiple proven cases of SBD.
• Inclusion of illustrative diagrams and radiological images.
• Discussion of distinct imaging features for diagnosis.

Main Results:

• SBD can cause anemia, malabsorption, diarrhea, and complications like inflammation, perforation, hemorrhage, obstruction, and tumor formation.
• SBD are a potential cause of benign, non-surgical pneumoperitoneum.
• Diagnostic pitfalls exist, with SBD sometimes mimicking other abnormalities.

Conclusions:

• Accurate diagnosis of SBD on cross-sectional imaging is often missed.
• Radiologists need to be aware of SBD's imaging features for confident diagnosis.
• Understanding SBD imaging is vital for managing diverse clinical presentations and complications.