The patient is a 79-year-old woman with a history of chronic, vague abdominal pain. Physical examination was unremarkable, and there were no significant laboratory findings.
Prepared by Cynthia Janus, MD and Gargi Patel, MD, of Drs.
Sheer, Ahearn, & Assoc., Team Physicians of Florida, P.A.,
The patient is a 79-year-old woman with a history of chronic,
vague abdominal pain. Physical examination was unremarkable, and
there were no significant laboratory findings.
Primary acquired jejunoileal diverticulosis
A double-contrast upper GI series failed to demonstrate any
evidence of an ulcer or mass lesion. A small-bowel series, however,
revealed extensive diverticulosis involving the entire length of
the small bowel with diverticula ranging in size from 5 mm to 2.5
cm (figure 1). There was no evidence of associated inflammatory
change, fistulae, or mass effect. The patient subsequently
underwent a barium enema examination, which demonstrated extensive
involvement of the entire large bowel with diverticula (figure
Primary acquired jejunoileal diverticulosis is an unusual
entity. The diverticula are classified as false diverticula and
result from herniation of mucosa and submucosa through the muscular
layer of the bowel wall.
The diverticula usually occur at the mesenteric border of the bowel
and can vary in size from a few millimeters to >10 cm. The
incidence of jejunoileal diverticulosis as determined at surgery,
at postmortem evaluation, or by enteroclysis has been reported to
be between 1.1% and 2.3%. Associated diverticula are found in the
colon in 35% to 75% of cases.
Small-bowel motor dysfunction has been postulated as an
etiology, and the entity has been associated with abnormalities,
such as scleroderma, involving a myopathic or neuropathic
abnormality. It has been proposed that disordered contractions of
the abnormal portion of the small bowel secondary to motor
dysfunction of the smooth muscle or myenteric plexus causes
increased intraluminal pressure. This results in herniation of
mucosa and submucosa through the weakest part of the bowel wall at
the site of penetration of mesenteric paired blood vessels.
Patients are usually elderly, in the seventh decade and above.
Most cases are asymptomatic. However, jejunoileal diverticulosis
can be the cause of vague, chronic symptoms as in the case shown
here. Most patients can be managed medically. However, the disorder
may be associated with enterolith ileus,
bacterial overgrowth, and malabsorption and can also result in
other serious complications including severe inflammation, abcess,
hemorrhage, and perforation.
Computed tomography may be helpful in diagnosing and defining the
extent of related complications. Diagnosis of the abnormality is
Although rare, this disorder should be considered in the
evaluation of patients with nonspecific, chronic abdominal
complaints or undiagnosed gastrointestinal bleeding.