Abdomen, Emergency, Small bowel, CT, CT-Angiography, Contrast agent-intravenous, Acute, Inflammation
C. Massimo1, A. G. Tucci2, B. Cusati2, B. Guarino3, A. Ragozzino2; 1Naples/IT, 2Napoli/IT, 3Sant'Antimo/IT
Diverticula are out-pouchings of the bowel wall emerging on the mesenteric border that represent mucosal herniation through weak points of the intestinal wall.
Diverticula can be ubiquitarious along the intestinal tract; most frequently they are located in the left colon and sigma,
but can be found in decreasing frequency in the duodenum,
jejunum and ileum.
Small bowel diverticula can be classified in two entities: acquired and congenital.
- Acquired diverticula are false diverticula because lack the muscular layer.
They are thought to be caused by a pulsion mechanism,
with the mucosa and submucosa pushing on the muscular layer.
- Congenital diverticula are represented by Meckel’s diverticulum,
the most common congenital anomaly of the gastrointestinal tract,
with an estimated prevalence of 2% in the population.
It is a true diverticula,
formed by all layers of the intestinal wall,
usually located 100 cm within the ileocecal valve.
It origins from an incomplete atrophy of the omphalomesenteric duct.
Small bowel diverticula usually remain asymptomatic until complications occur.
Complications comprise diverticulitis,
obstruction and torsion.
Mortality is influenced by patients' age,
severity of complications and surgery.
Due to their larger dimensions and fluid content,
small bowel diverticulitis is far less common than colonic diverticulitis,
so that radiologists are not familiar with this condition.
clinical presentation is unspecific and patients usually complain abdominal pain and tenderness.
For those reasons,
a broad spectrum of diseases has to be considered as a cause of acute abdominal pain,
making the diagnosis more challenging.