Schmidt P, Perniss A, Nassenstein C, Keller H, Deckmann K. Multiple jejunal diverticulosis, from an anatomical and histological view: A case report. World J Gastrointest Surg 2025; 17(7): 104985 [DOI: 10.4240/wjgs.v17.i7.104985]
Corresponding Author of This Article
Klaus Deckmann, Senior Researcher, Institute for Anatomy and Cell Biology, Justus-Liebig-University Giessen, Aulweg 123, Giessen 35392, Hesse, Germany. klaus.deckmann@anatomie.med.uni-giessen.de
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Jul 27, 2025; 17(7): 104985 Published online Jul 27, 2025. doi: 10.4240/wjgs.v17.i7.104985
Multiple jejunal diverticulosis, from an anatomical and histological view: A case report
Patricia Schmidt, Alexander Perniss, Christina Nassenstein, Hanno Keller, Klaus Deckmann
Patricia Schmidt, Alexander Perniss, Christina Nassenstein, Klaus Deckmann, Institute for Anatomy and Cell Biology, Justus-Liebig-University Giessen, Giessen 35392, Hesse, Germany
Patricia Schmidt, Leibniz Institute on Aging, Fritz Lipmann Institute, Jena 07745, Thuringia, Germany
Alexander Perniss, Division of Allergy and Clinical Immunology, Brigham and Women's Hospital and Department of Medicine, Harvard Medical School, Boston, MA 02115, United States
Hanno Keller, Laboratory of Experimental Surgery, Department of General and Thoracic Surgery, Justus-Liebig-University Giessen, Giessen 35392, Hesse, Germany
Co-first authors: Patricia Schmidt and Alexander Perniss.
Author contributions: Schmidt P and Perniss A contributed equally to this study as co-first authors; Deckmann K, Schmidt P, Keller H, and Perniss A performed the experiments, prepared the necessary materials, and recorded the data photographically; Deckmann K obtained funding; Deckmann K, Schmidt P, Nassenstein C, and Perniss A drafted the manuscript; All authors have read and approved the final manuscript.
Supported by University Hospital of Giessen and Marburg (UKGM)-Justus-Liebig-University (JLU)-Cooperation Grant, No. 7/2016 GI; the Else Kröner-Fresenius-Stiftung, No. 2016_A90; and the German Research Foundation, No. 544054869.
Informed consent statement: This report protects the body donors’ privacy and anonymity. The authors ensure that the body name and initials would not be published and that due efforts would be made to conceal his identity. The cadaver described in this case report was a body donor who gave written informed consent during lifetime for the postmortem use of his body for research and education. It was obtained from the body donation program of the Justus-Liebig-University. A release from medical confidentiality obligations was given by the bereaved. This allowed us to retrieve the clinical records from the period of three years before death. The research was performed in accordance with the guidelines from the Declaration of Helsinki.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Klaus Deckmann, Senior Researcher, Institute for Anatomy and Cell Biology, Justus-Liebig-University Giessen, Aulweg 123, Giessen 35392, Hesse, Germany. klaus.deckmann@anatomie.med.uni-giessen.de
Received: January 9, 2025 Revised: March 18, 2025 Accepted: May 7, 2025 Published online: July 27, 2025 Processing time: 196 Days and 2.4 Hours
Abstract
BACKGROUND
Here, we report a case of jejunal diverticulosis from an anatomical and histological view. During the “Gross Anatomy course,” we found multiple jejunal diverticula along a total length of 208 cm of intestine.
CASE SUMMARY
After opening the intestinal tract, we counted 232 jejunal diverticulum entry points with a diameter of up to 2 cm and observed connections between the diverticula that created shortcuts between two distinct intestinal parts. Interestingly, we observed an extreme longitudinal striation on the intestinal parts hosting diverticula. Thorough vessel preparation utilizing a dissecting microscope confirmed that all investigated arteriae rectae ended in a diverticulum. Histological and immunohistochemical investigations revealed that intestinal villi of diverticula were smaller and less prominent than control tissue and that the stratum longitudinale, as well as the stratum circular, were much thinner in the diverticula compared to control tissue. Neither submucosal nor mesenteric plexus could be detected in the diverticula. However, vasoactive intestinal peptide-positive nerve fibers and villin-positive brush border could only be detected in control tissue. This indicates that jejunal diverticulosis is associated with abnormalities of the smooth muscles and a disorder of innervation.
CONCLUSION
Jejunal diverticulosis originates from mesenteric vessels, featuring smooth muscle changes, absent innervation, and thinning of tissue layers.
Core Tip: Diverticulosis, which mainly affects older people, is often associated with diverticulitis. Abnormal peristalsis and increased intraluminal pressure cause the formation of diverticula. During the course “Gross Anatomy,” we found a case of multiple jejunal diverticula. We counted 232 jejunal diverticulum entry sites over a total length of 208 cm of intestine. Here, we showed the correlation between visible changes in the smooth muscle architecture and the microscopic structures, as well as the correlation with previously observed clinical symptoms. These findings notably support the theory that abnormalities in the smooth musculature lead to pathological remodeling of the intestine.
