Small bowel diverticular disease: are we clinically aware?

Small bowel diverticulum (SBD) is an outpouching of the small intestinal wall and is often neglected in clinical practice due to its undiscerning location. Majority of SBD can be asymptomatic but can also be associated with life-threatening complications. We hereby performed a clinical analysis to investigate the characteristics associated with SBD.

This retrospective case series analyzed clinical data from two tertiary referral centers. Clinical data including baseline characteristics, clinical presentation, diagnostic methods and treatment were systematically collected and reviewed. Subgroup analysis based on distinct location of the SBD, such as the duodenum, jejunum and ileum were also performed.

A total of 149 cases of SBD were ultimately included in the present study analysis. Among 114 duodenal SBD cases, 42 (36.8%) were asymptomatic, while 58 (50.9%) presented with pain/discomfort. In contrast, jejunoileal SBD (n = 35) were predominantly symptomatic: 21 (60.0%) required surgical intervention due to complications such as obstruction (n = 8), bleeding (n = 12), or perforation (n = 5). Endoscopic modalities (DBE/VCE) achieved a diagnostic accuracy of 92.3% for jejunoileal SBD, surpassing radiological methods (CT/BaFT) at 38.5% (p < 0.001). Distinctive case highlights also provided examples of SBD found at different locations.

Small bowel diverticular (SBD) disease is often overlooked in clinical practice, due to its discrete location and limited access. With continuous diagnostic advancements, including endoscopic techniques, the detection of SBD is expected to rise, gaining clinical awareness amongst gastroenterologists.