Small-bowel diverticulosis: perceptions and reality

Small-bowel diverticulosis is a rare entity that can be discovered incidentally during celiotomy, endoscopy, or radiographic imaging studies. The reported complication rate is low, giving rise to the current recommendation not to treat uncomplicated small-bowel diverticula.

A retrospective review was performed of patients with small-bowel diverticulosis seen during 23 years at three major institutions.

Two hundred eight patients were identified. Diverticula were located in the duodenum in 79 percent; in the jejunum or ileum in 18 percent; and in duodenum, jejunum, and ileum in 3 percent. Complications developed in 42 of the 208 patients (20 percent) including bleeding in 14, diverticulitis with perforation and abscess formation in 12, and malabsorption in 8. When assessed by location, jejunoileal diverticula were more likely to have complications than duodenal diverticula: 46 percent compared to 13 percent (p < .01). Bleeding accounted for 52 percent of the duodenal complications compared to 12 percent of the jejunoileal complications (p < 05). Jejunoileal diverticula were more likely to perforate and develop abscesses (21 percent compared to 1.2 percent; p < .001).

The low incidence of complications associated with duodenal diverticula justifies a nonoperative approach. The higher complication rate associated with jejunoileal diverticula will be necessary to define that approach more exactly.