Small Intestine Diverticula - Know It All

Introduction

The small intestine is a long and important body part since it is responsible for the absorption of water, nutrients, and minerals from the food that leaves the stomach. The small intestine consists of three segments:

• Duodenum- Receives food, bile, and pancreatic juices and aids in breaking down nutrients.

• Jejunum- It is responsible for absorbing most nutrients, while the ileum absorbs B vitamins and other remaining substances.

• Ileum- It is responsible for the absorption of B vitamins and other remaining substances.

Diverticula are bulging pouches that can develop in the gastrointestinal system (small intestine or large intestine). The diverticula of the small intestine is rare and can be seen throughout the length of the small intestine. Diverticula of the small intestine were first reported in 1907, and they are considered to be quite rare compared to other types of diverticula. Less than five percent of all reported cases of diverticula involve the small intestine.

What Are the Types of Small Intestine Diverticula?

The diverticula of the small intestine can be classified into various types. Based on etiology, diverticula of the small intestine are divided into:

• Congenital Diverticula of the Small Intestine - Born with diverticula involving the small intestine.

• Acquired Diverticula of the Small Intestine - Diverticula of the small intestine occurs as one ages due to other causative factors, such as the weakening of the intestinal epithelium.

Based on the relation to the intestinal lining (lumen), the diverticula of the small intestine are divided into:

• Intraluminal Diverticula: The diverticula protrude into the inside (lumen) of the small intestine. They are also known as true diverticula. Meckel's diverticulum is the most well-known example of an intraluminal diverticulum in the small intestine.

• Extraluminal Diverticula: The diverticula occur on the outside of the small intestine, usually due to weakening or herniation of the intestinal wall. They are also referred to as false diverticula. Extraluminal diverticula may be found in the duodenum, jejunum, ileum, and jejunoileal regions of the small intestine.

What Are the Symptoms of Small Intestine Diverticula?

In most cases, small intestine diverticula do not cause any symptoms and are discovered incidentally during medical imaging or procedures. However, the symptoms of small intestine diverticula can vary depending on the location, size, and presence of complications. Symptoms of small intestine diverticula (if they do occur) may include:

• Abdominal Pain- It is the most common symptom associated with small intestine diverticula. The pain is typically crampy or colicky and may be intermittent or persistent. The location of the pain can change depending on the location of the diverticula within the small intestine.

• Bloating and Distension- Some individuals with small intestine diverticula may experience bloating and abdominal distension, which can be caused by impaired bowel function or the accumulation of gas in the diverticula.

• Nausea and Vomiting- In some cases, small intestine diverticula can lead to nausea and vomiting, particularly if they cause a blockage (obstruction) or if there is inflammation or infection.

• Change in Bowel Habits- Small intestine diverticula can sometimes affect the normal movement of the bowel, leading to changes in bowel habits such as diarrhea or constipation.

• Gastrointestinal Bleeding- Rarely, small intestine diverticula can bleed, resulting in symptoms like blood in the stool or black, tarry stools.

What Causes Small Intestine Diverticula?

The exact cause of small intestine diverticula is not known but they are believed to develop due to a combination of factors. Some possible causes and contributing factors may include:

• Weakness in the Intestinal Wall- The small intestine's wall may develop areas of weakness over time, making it more prone to the formation of diverticula. This weakness can be caused by age-related changes, chronic inflammation, or structural abnormalities.

• Increased Pressure- When there is increased pressure inside the small intestine, it can put a strain on the intestinal wall and lead to the formation of diverticula. Factors that can contribute to increased pressure include constipation or straining during bowel movements causing muscle contractions that are stronger than usual.

• Lack of Dietary Fiber- A diet low in fiber may contribute to the development of small intestine diverticula. Fiber helps to soften the stool and promote regular bowel movements, reducing pressure inside the intestine.

• Genetic Factors- There may be a genetic predisposition to developing diverticula in some individuals, as the condition can run in families.

How to Diagnose Small Intestine Diverticula?

Since, in most cases, small intestine diverticula do not necessarily show any symptoms, diagnosis may be difficult. On presenting symptoms of small intestine diverticula, the following measures may help in diagnosis:

• Physical Examination: Physical examination to check for any signs of tenderness or abnormality focusing on the abdomen.

• Imaging Tests: Imaging tests can provide detailed images of the small intestine and help identify the presence and location of the diverticula of the small intestine. Some of the imaging tests used are:

  • Computed tomography (CT) scan.

  • Magnetic resonance imaging (MRI).

  • Barium X-ray: This involves drinking a contrast material (barium) that coats the small intestine, making it visible on X-ray images.

  • Capsule Endoscopy: In this procedure, one is asked to swallow a small capsule containing a camera that takes images as it travels through the digestive tract.

• Biopsy: If any abnormalities are found during an endoscopic procedure, a biopsy may be performed to collect a small tissue sample for further examination.

How to Treat Small Intestine Diverticula?

Treatment of small intestine diverticula is primarily aimed at reducing pain and preventing complications.

• Medications: Medications are prescribed to relieve any symptoms of pain or infections.

  • Pain Relief: Over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or Acetaminophen, may help alleviate pain associated with diverticula.

  • Antispasmodics: Antispasmodic medications (for example, Hyoscyamine) can help relax the muscles of the intestine, reducing cramping and discomfort.

  • Antibiotics: If infection or inflammation is present, antibiotics (for example, Ciprofloxacin) may be prescribed to combat the infection.

• Dietary Modifications: Consuming a diet rich in fiber can help soften the stool and prevent constipation, reducing the strain on the intestines and potentially minimizing symptoms and complications. Drinking an adequate amount of fluids can maintain hydration and promote regular bowel movements.

• Surgical Intervention: In rare cases where intestinal obstruction, perforation, or severe bleeding is presented, surgery may be required to remove the affected portion of the small intestine or repair the damage to the small intestine.

Conclusion

Although rare and asymptomatic for most individuals, small intestine diverticula is a condition to be careful about; with the availability of appropriate conservative treatment measures, one must try to be careful in order to prevent diverticula complications such as intestinal perforations or internal bleeding. With proper management of the condition, one may be able to experience a significant improvement in health.