Nonspecific Epigastric Pain, Bloating

Patients generally present with nonspecific epigastric pain and bloating.

Figure 1. Contrast-enhanced axial CT image demonstrates white arrows pointing to several 2-3 cm saccular outpouchings arising from mid jejunal loops within the left upper quadrant. Note the “fecalization” of small bowel contents within the lumen indicating stasis, and delayed emptying of contents.

Figure 2. Contrast-enhanced axial CT image demonstrates white arrows pointing to several 2-3 cm saccular outpouchings arising from mid jejunal loops within the left upper quadrant. Note the “fecalization” of small bowel contents within the lumen indicating stasis, and delayed emptying of contents.

Figure 3. Contrast-enhanced coronal CT image from the same patient demonstrating white arrows pointing to several of these small bowel diverticulae with wall thickening, and stranding of the mesenteric fat, indicating diverticulitis.

Figure 4. Contrast-enhanced coronal CT image from the same patient demonstrating white arrows pointing to several of these small bowel diverticulae with wall thickening, and stranding of the mesenteric fat, indicating diverticulitis.

Small bowel diverticular disease is a somewhat rare entity, occurring with much less frequency than diverticular disease involving the large intestine.

Unlike Meckel’s diverticulum, small bowel diverticula are acquired, and their incidence increases with age.

In most cases, conservative management with antibiotics, bowel rest, IV hydration, and nutritional supplementation (increased fiber, cellulose bran intake in the diet), will be appropriate.

Small bowel diverticula can occur within any segment of the small bowel: duodenal, jejunal, ileal, or jejunoileal.