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Diverticulosis & Obscure Bleeding :
Gastroenterology Surgery
Diverticulosis & Obscure Bleeding India offers information on Diverticulosis & Obscure Bleeding in India, Diverticulosis & Obscure Bleeding cost India, Diverticulosis & Obscure Bleeding hospital in India, Delhi, Mumbai, Chennai, Hyderabad & Bangalore, Diverticulosis & Obscure Bleeding Surgeon in India.

Small intestinal diverticulosis refers to the clinical entity characterized by the presence of multiple saclike mucosal herniations through weak points in the intestinal wall. Small intestinal diverticula are far less common than colonic diverticula. The singular form is diverticulum, and the plural form is diverticula.


The cause of this condition is not known. It is believed to develop as the result of abnormalities in peristalsis, intestinal dyskinesis, and high segmental intraluminal pressures.

The resulting diverticula emerge on the mesenteric border, ie, sites where mesenteric vessels penetrate the small bowel. Diverticula are classified as true and false. True diverticula are composed of all layers of the intestinal wall, whereas false diverticula are formed from the herniation of the mucosal and submucosal layers. Meckel diverticulum is a true diverticulum. Diverticula can be classified as intraluminal or extraluminal.

Intraluminal diverticula and Meckel diverticulum are congenital. Extraluminal diverticula may be found in various anatomic locations and are referred to as duodenal, jejunal, ileal, or jejunoileal diverticula.


United States

Duodenal diverticula are approximately 5 times more common than jejunoileal diverticula. The actual incidence of both types of diverticula is not known because these lesions are usually asymptomatic. The incidence at autopsy of duodenal diverticula is 6-22%. Jejunal diverticula are less common, with a reported incidence of less than 0.5% on upper GI radiographs and a 0.3-1.3% autopsy incidence.


Incidence parallels that in the United States.


Small bowel diverticula are generally asymptomatic, with the exception of Meckel diverticulum. Major complications include diverticulitis, GI hemorrhage, intestinal obstruction, acute perforation, and pancreatic and/or biliary disease in duodenal diverticula. Mortality is influenced by patients' age, nature of complications, and timeliness of intervention.

Most patients with small bowel diverticula are asymptomatic. Patients who develop symptoms generally report symptoms that reflect associated complications. The most common symptom is nonspecific epigastric pain or a bloating sensation. Complication rates as high as 10-12% for duodenal diverticulosis and 46% for jejunal diverticulosis have been reported.

These complications include the following : Physical

Physical findings are also related to the complications mentioned above. These findings include abdominal fullness, localized or vague tenderness, rectal bleeding, and melena.

No set of symptoms or signs is pathognomonic for small bowel diverticulosis. In the absence of complications, history and physical examination findings are often negative.

Some of these symptoms may be manifestations of other unrelated comorbid conditions. The exact rate of these complications is difficult to estimate but has been reported to be from 10-40%.

Hemorrhage and pancreaticobiliary disease are the most common complications of duodenal diverticulum, while diverticulitis and perforation are more common with jejunoileal diverticula. Intestinal obstruction is a feature of intraluminal duodenal diverticulum, while Meckel diverticulum can be complicated by peptic ulcer infection and intestinal obstruction. Most patients are diagnosed serendipitously.

Specific features based on anatomic location and type

The following risk factors apply to acquired pseudodiverticula : -

Laboratory Studies

Laboratory tests have limited value in diagnosing small bowel diverticulosis. The following tests may be indicated. Imaging Studies

Plain abdominal radiograph and/or chest radiograph demonstrates evidence of perforation, including air under the diaphragm; free peritoneal air; evidence of intestinal obstruction; or evidence of ileus, including multiple air-fluid levels and bowel dilatation.

Abdominal CT scan with contrast provides more information in complicated as well as uncomplicated cases. Phlegmon can be identified, especially in the retroperitoneal space, providing the initial clue to the possibility of small intestinal diverticular disease.

A double contrast barium meal and enteroclysis is useful in diagnosis but is contraindicated in acute diverticulitis or perforation.

Other Tests

Bleeding scan: This is used to determine the site of bleeding if the patient is hemodynamically stable. It is helpful in localizing bleeding sites, detecting bleeding as slow as 0.5 cc/min.

Mesenteric angiography: This is used for brisk hemorrhages to identify the bleeding site and offers the opportunity for mesenteric occlusion therapy.

Procedures Double balloon enteroscopy can help identify the presence of disease and also the cause of any obscure bleeding. This procedure can also therapeutically intervene at the identified site of bleed. This is where the small bowel is pleated proximally on the scope to advance distally through the small bowel.

Capsule endoscopy helps identify the presence of diverticular disease and also the cause of bleeding. This procedure is excluded in small bowel obstruction, acute diverticulitis, or perforation. This procedure involves swallowing a capsule with a battery source, camera, and broadcasting capacity. The signals/images are sent to a device worn on the belt and recorded for further evaluation. The pill passes in the feces and does not need to be retrieved.


Medical Care

The general recommendation favors a conservative approach to the management of asymptomatic diverticula. They are generally left alone unless they can be related to diseases. In certain locations, diverticula are associated with special complications. For example, periampullary diverticula can be associated with pancreatitis, cholangitis, or recurrent choledocholithiasis after cholecystectomy. Intraluminal diverticula are observed in the duodenum.

They can be complicated by intestinal obstruction and biliary and pancreatic diseases. A higher complication rate is associated with jejunoileal diverticulosis and, as such, may justify less conservative approach to its management. Capsule endoscopy might be of value if available to identify the site of the bleed. Push enteroscopy should be used once a lesion amenable to therapeutic intervention has been identified.

Prehospital care

Acute abdomen and obvious and occult GI hemorrhage are the clinical scenarios that necessitate prehospital intervention. Vascular access, intravenous fluid, oxygen, and prompt transport to the hospital are all that is required in the field. Surgical Care

Complications of small bowel diverticulosis, such as massive bleeding or diverticulitis with perforation, require surgery. Diagnosis is seldom made preoperatively. The aim is to control complications when present and/or to prevent future complications.

Emergency surgery is indicated for severe diverticulitis, intestinal perforation, intestinal obstruction, and hemorrhage that continue after conservative management.

Several operative procedures are available depending on the type of diverticulum, site, and nature of complications.

Simple diverticulectomy

This is most commonly used for symptomatic diverticulum or bleeding diverticulum of the duodenum. The diverticulum is simply excised, and the bowel is closed longitudinally or transversely, ensuring minimal luminal stenosis.

This procedure requires modification in cases involving a diverticulum that is embedded deep in the head of the pancreas or is associated with the ampulla of Vater, is perforated, or is intraluminal in location. It can be technically difficult in the presence of common duct obstruction. These patients benefit more from choledochoduodenostomy.

Meckel diverticulum can also be removed by this technique.

Intestinal resection and end-to-end anastomosis

This is the preferred approach to jejunoileal diverticulum, which tends to be multiple, irrespective of types of


Consultation with a general surgeon is indicated for all patients requiring surgical management. A gastroenterologist assists with diagnosis and follow-up strategy and performs both diagnostic and therapeutic endoscopy.


The role of diet is not clear. A high-fiber diet that improves bowel motility and is used in colonic diverticulosis may be beneficial.


No restriction of activity is indicated.
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