Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1979 Aug;190(2):183–188. doi: 10.1097/00000658-197908000-00011

Major Complications of Small Bowel Diverticula

John W Donald
PMCID: PMC1344486  PMID: 111637

Abstract

Complications of diverticula of the duodenum, jejunum and ileum, exclusive of Meckel's diverticula are extremely rare but can produce major diagnostic and therapeutic problems. Major reported complications include hemorrhage, perforation, biliary and pancreatic obstruction, and inflammation with intestinal obstruction. The mortality of complicated duodenal diverticula is reported from 33 to 48%. Our experience with some of these complications is reported. This experience and a review of other reported cases have led to the following recommendations for surgical treatment. 1) Massively bleeding duodenal diverticulum. Precise localization of the bleeding point by endoscopy and/or arteriography is highly desirable. Excision or partial excision of the diverticulum with suture ligation of the bleeding point is necessary. 2) Perforated duodenal diverticulum. Excision or partial excision, secure closure and drainage are necessary. If peri-Vaterian, a probe should be passed through the ampulla of Vater via the common duct. Unless an entirely satisfactory closure is achieved, complete diversion of the enteric stream from the duodenum by vagotomy, antrectomy with closure of duodenal stump, and Billroth II anastomosis is recommended. 3) Choledochal obstruction due to duodenal diverticulum. Choledocho-duodenostomy. 4) Perforation, bleeding, or obstruction due to jejunal or ileal diverticulum. In rare cases, local excision of the diverticulum is feasible. Usually, resection of the involved segment with primary anastomosis is indicated.

Full text

PDF
185

Images in this article

185Fig. 1.
on p.185
185Fig. 2.
on p.185
186Fig. 3.
on p.186
186Fig. 4.
on p.186
187Fig. 5.
on p.187
187Fig. 6.
on p.187

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. CATTELL R. B., MUDGE T. J. The surgical significance of duodenal diverticula. N Engl J Med. 1952 Feb 28;246(9):317–324. doi: 10.1056/NEJM195202282460901. [DOI] [PubMed] [Google Scholar]
  2. Ettman I. K., Kongtawng T. Massive gastrointestinal bleeding and perforation of a duodenal diverticulum with coexisting pancreatitis. South Med J. 1977 Jun;70(6):761–763. doi: 10.1097/00007611-197706000-00037. [DOI] [PubMed] [Google Scholar]
  3. Graves H. A., Jr, Durrett D. W., Jr, Holcomb G. W., Jr Perforated duodenal diverticulitis. Am J Surg. 1966 Dec;112(6):908–911. doi: 10.1016/0002-9610(66)90149-8. [DOI] [PubMed] [Google Scholar]
  4. HERRINGTON J. L., Jr Massive hemorrhage resulting from benign ulceration in a primary duodenal diverticulum. Surgery. 1958 Feb;43(2):340–344. [PubMed] [Google Scholar]
  5. Landor J. H., Fulkerson C. C. Duodenal diverticula. Relationship to biliary tract disease. Arch Surg. 1966 Jul;93(1):182–188. doi: 10.1001/archsurg.1966.01330010184023. [DOI] [PubMed] [Google Scholar]
  6. McSherry C. K., Glenn F. Biliary tract obstruction and duodenal diverticula. Surg Gynecol Obstet. 1970 May;130(5):829–836. [PubMed] [Google Scholar]
  7. Miller R. E., McCabe R. E., Salomon P. F., Knox W. G. Surgical complications of small bowel diverticula exclusive of Meckel's. Ann Surg. 1970 Feb;171(2):202–210. doi: 10.1097/00000658-197002000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Munnell E. R., Preston W. J. Complications of duodenal diverticula. Arch Surg. 1966 Jan;92(1):152–156. doi: 10.1001/archsurg.1966.01320190154034. [DOI] [PubMed] [Google Scholar]
  9. NICHOLS H. T., BLANCO G., URICCHIO J. F., LIKOFF W. Open-heart surgery for mitral regurgitation and stenosis. Arch Surg. 1961 Jan;82:128–137. doi: 10.1001/archsurg.1961.01300070132016. [DOI] [PubMed] [Google Scholar]
  10. Neel H. B. Obstruction of the common bile duct. Duodenal diverticula. Minn Med. 1972 Dec;55(12):1118–1120. [PubMed] [Google Scholar]
  11. Nobles E. R., Jr Jejunal diverticula. Arch Surg. 1971 Mar;102(3):172–174. doi: 10.1001/archsurg.1971.01350030010002. [DOI] [PubMed] [Google Scholar]
  12. SHACKELFORD R. T., MARCUS W. Y. Jejunal diverticula--a cause of gastro-intestinal hemorrhage: a report of three cases and review of the literature. Ann Surg. 1960 Jun;151:930–938. doi: 10.1097/00000658-196006000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Smith J. S. Jejunal diverticula--subtle cause of acute abdomen. Pa Med. 1976 Feb;79(2):60–63. [PubMed] [Google Scholar]
  14. Solhaug J. H., Semb B. K. Duodenal diverticulum with intermittent biliary stasis. Acta Chir Scand. 1974;140(8):670–673. [PubMed] [Google Scholar]
  15. Viar W. N., Donald J. M., Jr Jejunal diverticulitis. J Med Assoc State Ala. 1966 Mar;35(9):705–709. [PubMed] [Google Scholar]
  16. Wilkinson G., Greaney E. M., Jr Perforated perivaterian duodenal diverticulitis. Am J Surg. 1966 Mar;111(3):351–355. doi: 10.1016/s0002-9610(66)80010-7. [DOI] [PubMed] [Google Scholar]
  17. Willox G. L., Costopoulos L. B. Entry of common bile and pancreatic ducts into a duodenal diverticulum. Cause of pancreaticobiliary disease. Arch Surg. 1969 Apr;98(4):447–450. doi: 10.1001/archsurg.1969.01340100079009. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES