From the Research
Jejunal diverticulosis is a rare condition that requires prompt diagnosis and management to prevent complications, and the most recent and highest quality study suggests that a CT scan is the mainstay for accurate diagnosis, and a proposed management algorithm can aid in selecting patients suitable for conservative management 1.
Overview of Jejunal Diverticulosis
Jejunal diverticulosis is characterized by the formation of multiple outpouchings or sacs in the wall of the jejunum, the middle segment of the small intestine. Most cases are asymptomatic and discovered incidentally during imaging or surgery for other conditions.
Management of Jejunal Diverticulosis
No specific treatment is required for asymptomatic jejunal diverticulosis. For symptomatic patients, management depends on the presentation. Mild symptoms like abdominal discomfort may be managed with a high-fiber diet, probiotics, and occasional antibiotics like rifaximin 400mg three times daily for 7-10 days to address bacterial overgrowth.
- Complications such as diverticulitis, bleeding, perforation, or obstruction require more aggressive intervention.
- Acute complications often necessitate hospitalization with bowel rest, intravenous fluids, and broad-spectrum antibiotics (e.g., piperacillin-tazobactam 3.375g IV every 6 hours plus metronidazole 500mg IV every 8 hours).
- Surgical intervention, typically segmental resection of the affected jejunum with primary anastomosis, is reserved for severe or recurrent complications, perforation, obstruction, or significant bleeding.
Importance of Regular Follow-up
The condition develops due to increased intraluminal pressure and weakening of the intestinal wall, often associated with aging, with most cases occurring in patients over 60 years old. Regular follow-up is important for patients with known jejunal diverticulosis to monitor for potential complications, as suggested by studies 2, 3, 4, 5.
Diagnostic Challenges
Diagnosing jejunal diverticulitis can be challenging due to non-specific symptoms, and a high index of suspicion is necessary, especially in older adults presenting with abdominal pain, as highlighted in the study 1.
Treatment Approach
A proposed management algorithm can aid in selecting patients suitable for conservative management, and surgical intervention should be considered for complicated cases, as discussed in the study 1.