Incidence, factors, and resultant management associated with small bowel diverticular perforation: A retrospective...

Small bowel diverticula are uncommon, often asymptomatic, and typically discovered incidentally. Small bowel diverticulitis with perforation is even more rare and potentially life-threatening.

Given the paucity of literature and lack of management guidelines, a single-center retrospective study was conducted from 2015 to 2024 on patients diagnosed with small bowel diverticulitis.

Of 32 patients with small bowel diverticulitis, 14 (44%) had perforation. Eight of these (57%) were managed operatively, including two initially treated non-operatively. All 32 patients received antibiotics with gram-negative and anaerobic coverage. Interestingly, about 34% of the patients in our sample were diagnosed in the year 2022 alone. Patients with perforated small bowel diverticulitis had a longer mean length of stay at 10.2 days in comparison to those without at 4.9 days (p = 0.056). All patients with small bowel diverticulitis without perforation did not need any surgical intervention and were managed nonoperatively (p = 0.0001). All patients who underwent surgery had abdominal pain and CT findings of contained perforation or extraluminal air/fluid.

This is one of the largest single center studies in the US focusing on perforated small bowel diverticulitis. For patients without perforation, they were all managed non-operatively. The study highlights the rarity of the condition and offers insight into its presentation and management over nearly a decade.