Jejunoileal diverticula

Jejunoileal diverticula are estimated to occur in 1-5% of the population. The incidence increases with age, peaking at the sixth and seventh decades. The pathogenesis is believed to involve an acquired defect of the intestinal smooth muscle or myenteric plexus. Eighty percent of jejunoileal diverticula are localized to the jejunum, 15% to the ileum, and 5% to both. Diverticula in the jejunum tend to be large and multiple, whereas those in the ileum are small and solitary. Symptoms of intermittent abdominal pain, flatulence, diarrhea, and constipation are reported in 10-30% of patients with jejunoileal diverticula. The radiographic diagnosis of these diverticula is difficult to establish. Enteroclysis should be reserved for patients who have persistent abdominal pain despite nonrevealing endoscopic and contrast enhanced studies of the upper and lower gastrointestinal tracts. Asymptomatic jejunoileal diverticula should be managed conservatively. Complications occur in 6-10% of patients and include obstruction, diverticulitis, hemorrhage, perforation, malabsorption, and chronic debilitating abdominal pain. When surgical therapy is indicated, intestinal resection with primary anastomosis is the preferred treatment.