Diverticulosis of the small intestine: Report of three cases

Abstract Approximately 100 cases of diverticulosis of the small bowel are on record. The condition may be diagnosed by roentgen examination or discovered at operation, but the presence of diverticula is most often established at autopsy. Three cases are reported. The diagnosis was made at operation in two, and by barium meal in one. The latter case was confirmed at operation, the involved portion was resected, and the patient is now in excellent health. The first patient died following resection of five feet of small bowel. The second patient recovered after excision of the diverticula and an enteroenterostomy. (He had a gastroenterostomy three weeks previously for a duodenal ulcer.) A frequent clinical picture is vague abdominal pain associated with flatulence. Based on very careful studies, the incidence is approximately 0.6 per cent (1 in 200 patients). The two important factors in the pathogenesis are a point of lower resistance where the blood vessel enters the intestine, and an increase in the intraintestinal pressure. The development of the latter is explained on the basis of irregular intestinal contractions. According to this theory, a portion of the bowel relaxes while the segments on either side are contracting. These contractions force the mucous membrane into the gap where the blood vessel enters in the relaxed segment. Acquired diverticula of the small bowel are usually multiple, occur on the mesenteric border, and arise in the upper portion of the jejunum. The treatment is surgical, preferably resection of the bowel, but simple excision of the diverticula or a sidetracking operation may suit the case better. The condition is probably one of the most frequent causes of vague abdominal complaints.