Jejunoileal Diverticulosis - Causes, Symptoms, and Management

Introduction

Jejunoileal diverticulosis is a rare condition that affects the small intestine, specifically the jejunum and ileum. Small pouches or sacs known as diverticula form in the intestine wall in this condition. Jejunoileal diverticulosis is usually asymptomatic and is often discovered incidentally during imaging studies for other conditions. However, it can sometimes cause serious complications such as bleeding, perforation, and obstruction. The prevalence of jejunoileal diverticulosis is difficult to determine, but it is estimated to occur in less than 2% of the population. It is common in older adults, with the average age of diagnosis being around 60 years old.

What Is Jejunoileal Diverticulosis?

Multiple sac-like mucosal herniations characterize jejunoileal diverticulosis through weak points in the intestinal wall. Small diverticula are far less common than colonic diverticula.

What Is the Cause of Jejunoileal Diverticulosis?

The exact cause of jejunoileal diverticulosis is unknown but is related to increased pressure within the small intestine. The increased pressure is caused by various factors, such as chronic constipation, muscular weakness, and the intestine's structure changes.

What Are the Risk Factors for Jejunoileal Diverticulosis?

The following are the risk factors for jejunoileal diverticulosis-

• Age: The condition is more commonly seen in older individuals, with ages more than 60.

• Genetics: It is a possible genetic component to developing jejunoileal diverticulosis, as the condition appears to run in families.

• Structural Abnormalities: When such abnormalities are present in the small intestine, including strictures or narrowing, it increases the risk of diverticula.

• Malabsorption Disorders: Conditions that interfere with the absorption of nutrients in the small intestine, such as celiac disease or Crohn's disease, can increase the risk of developing jejunoileal diverticulosis.

• Chronic Constipation: Chronic constipation can increase the pressure within the small intestine, leading to the formation of diverticula.

• Immunosuppression: Individuals with weak immune systems, including those undergoing chemotherapy or with HIV/AIDS, may have a higher risk of developing the condition.

• Previous Abdominal Surgery: Previous abdominal surgery can cause adhesions and scarring, leading to structural abnormalities in the small intestine and increasing the risk of developing diverticula.

• Use of Non-steroidal Anti-inflammatory Drugs (NSAIDs): Long-term use of NSAIDs, such as Aspirin or ibuprofen, can increase the risk of developing jejunoileal diverticulosis.

What Are the Symptoms of Jejunoileal Diverticulosis?

The following are the symptoms of jejunoileal diverticulosis:

• Many people do not experience symptoms, and the condition was discovered incidentally during examination for other conditions.

• Some people with jejunoileal diverticulosis may experience abdominal pain, which can be mild to severe.

• Bloating or discomfort in the abdomen may be present in some cases.

• Some people may experience nausea and vomiting.

• Jejunoileal diverticulosis can cause changes in bowel habits, such as constipation or diarrhea.

What Are the Complications of Jejunoileal Diverticulosis?

The following are complications -

• Bleeding: Diverticula can bleed, leading to gastrointestinal bleeding. In severe cases, blood transfusions and surgical intervention may be necessary.

• Perforation: Diverticula can rupture, causing intestinal perforation. This requires immediate medical attention and hospitalization, and surgery may be necessary to repair the damage and prevent further complications.

• Obstruction: Diverticula can cause intestinal blockages, leading to bowel obstruction. This can cause abdominal pain, bloating, and vomiting, and surgery may be necessary to remove blockages.

• Inflammation and Infection: Diverticula can become inflamed or infected, causing symptoms such as fever, abdominal pain, and diarrhea. In serious patients, hospitalization and intravenous antibiotics may be necessary.

• Fistula Formation: In rare cases, diverticula can lead to the formation of a fistula, an abnormal connection between two organs or tissues. This can cause complications, such as infection, requiring surgical intervention to repair the fistula.

How to Diagnose Jejunoileal Diverticulosis?

Diagnosing jejunoileal diverticulosis typically involves imaging studies such as computed tomography (CT) scans or magnetic resonance imaging (MRI). These tests can show the presence of diverticula and any complications that may have arisen, such as bleeding, perforation, or obstruction. In some cases, an endoscopy or capsule endoscopy may be used to examine the small intestine and detect the presence of diverticula.

Blood and stool tests may also be performed to assess for signs of infection or bleeding. Because jejunoileal diverticulosis is rare, it is important to exclude the other possible causes of symptoms, including inflammatory bowel disease or colon cancer. A doctor will take a medical history and perform a physical examination to help diagnose the condition.

What Is the Treatment for Jejunoileal Diverticulosis?

Treatment for jejunoileal diverticulosis depends on the severity of the condition and any complications that may have occurred.

• Asymptomatic cases may not require treatment, but regular monitoring may be recommended to detect any changes or complications.

• In some cases, complications are seen, and hospitalization and surgical intervention become necessary.

1. Bleeding: If bleeding is severe, blood transfusions and surgical treatment become necessary to stop the bleeding and repair any damage.

2. Perforation: Perforation requires immediate medical attention and hospitalization. Surgery is required to repair damage and prevent further complications, including infection.

3. Obstruction: Obstruction can be treated with surgery to remove any blockages in the intestine and prevent further complications.

4. Dietary Changes: In some cases, dietary changes may be recommended to prevent or alleviate symptoms. This may include increasing fiber intake, avoiding foods that are difficult to digest, and maintaining a healthy weight.

5. Medications: Medications may be prescribed to alleviate symptoms such as abdominal pain and bloating.

Is it Possible to Prevent Jejunoileal Diverticulosis?

There are no specific measures that can be taken to prevent its development. However, some lifestyle modifications may help reduce the risk of complications and improve outcomes for those with the condition. These may include maintaining a healthy weight, adopting a high-fiber diet, staying hydrated, avoiding foods irritating the digestive system, avoiding smoking and excessive alcohol consumption, and managing underlying conditions such as Crohn's disease or celiac disease. Regular close monitoring and follow-up care are essential to detect and manage potential complications.

Conclusion

Jejunoileal diverticulosis is challenging to diagnose due to its rarity and non-specific symptoms. However, prompt and accurate diagnosis prevents complications and improves outcomes. Typically asymptomatic, jejunoileal diverticulosis is frequently found by accident during imaging tests for other disorders. Treatment options range from non-surgical approaches, such as dietary modifications and medications, to more invasive surgical interventions in severe cases. Close monitoring and follow-up care are necessary to manage the condition effectively.