Jejunal diverticular disease: A gastrointestinal bleeding enigma

Abstract

Diverticular disease (DD) represents a prevalent clinical challenge, especially in the aging population. The sigmoid colon is the most frequently affected area. However, the presence of DD in the upper gastrointestinal tract, including the duodenum and jejunum, underscores the need for comprehensive understanding and management. In this minireview we analyzed the epidemiology, pathogenesis, clinical presentation, diagnosis, and management of DD with a specific focus on jejunal diverticulosis. Although the incidence of gastrointestinal DD increases with age, the male and female prevalence is the same. Clinical presentation is either asymptomatic or with unclear abdominal symptoms. However, complications such as perforation and bleeding can occur in a subset of patients and demand urgent diagnosis and surgical treatment. Imaging alternatives, including CT and enteroscopy, play key roles in diagnosis. Surgical management is warranted in cases with persistent bleeding or more complicated acute abdomen. Jejunal diverticulosis (JD) is a less common condition and poses a unique diagnostic and therapeutic challenge. Bleeding has been reported as the most important complication in JD. Therefore, early diagnosis and management are critical to improve patient outcomes and reduce morbidity and mortality. This article highlighted the importance of considering JD in the differential diagnosis of gastrointestinal bleeding, especially in patients with concurrent colon diverticulosis in which the bleeding source remains unidentified. Therefore, current challenges in JD are better understanding the etiopathology and optimal management strategies.

Keywords: Gastrointestinal hemorrhage; Diverticula; Diverticulitis; Jejunum; Bleeding; Perforation

Core Tip: Diverticular disease is a common entity developing along the gastrointestinal tract. The sigmoid colon is the most frequently affected area. Ileojejunal diverticulosis is a less common presentation with a prevalence of 0.3%-2.3%. Diverticular disease is often described as asymptomatic. However, 12% of patients experience complications such as perforation, bleeding, and obstruction. Gastrointestinal diverticula is the leading cause of lower gastrointestinal bleeding, exceeding 20% in hospitalized patients. Although jejunal diverticula are less common, they show a higher tendency to bleed than diverticula in the colon. Therefore, early diagnosis and management are critical to improve patient outcomes and reduce morbidity and mortality.