Complications of acquired diverticula of the ileum

Acquired diverticula of the small bowel are extremely rare. These diverticula occur in less than one per cent of the population. Acquired diverticula of the ileum make up approximately ten per cent to 20 per cent of this number. Associated complications are noted in less than ten per cent of patients, but mortality rates related to these complications have been reported to range from 25 per cent to 50 per cent. Major reported complications include perforation, hemorrhage, and obstruction secondary to inflammation. Our experience with three cases of complicated ileal diverticula is presented. All patients presented with physical findings consistent with an acute abdomen, but the correct diagnosis was not made in any of these patients preoperatively. Two patients were found to have perforation of an ileal diverticulum: one with localized abscess formation and the other with diffuse peritonitis. The third patient had ileal diverticulitis without perforation. Two of the patients had resection and primary anastomosis. The third patient had resection and an ileostomy and mucous fistula created. Postoperatively, one patient died of a massive cerebrovascular accident. A thorough discussion of the literature concerning these rare acquired ileal diverticula is presented. Clinical manifestations, complications, and associated surgical therapy are discussed. Usually, resection of the involved segment with primary anastomosis can be performed.