Jejunal diverticulitis. Review and treatment algorithm.

Diverticulitis is much less common in the jejunum than in colonic diverticula probably because of diverticulum larger size, better intra-luminal flow and relatively sterile jejunal content. Complications of jejunal diverticulitis are acute intestinal obstruction, diverticular bleeding and mainly perforation with mesenteric abscess, localized or generalized peritonitis. The Multi-detector row computed tomography is now the best diagnostic imaging for small bowel diverticulitis as well as its complications. Magnetic resonance enterography is also quite useful but it is still impractical to resort to such an imaging in an abdominal emergency. Non-surgical treatment is usually sufficient for jejunal diverticulitis without peritonitis but it does not prevent recurrence of diverticulitis. Surgery is mandatory in case of generalized peritonitis or voluminous local abscess complicating small bowel diverticulitis. In case of extensive small bowel diverticulosis, resection should be limited to the intestinal loop with complicated diverticulum (local abscess, peritonitis or bleeding) to avoid short bowel syndrome. Poor prognostic factors are advanced age, associated comorbidities, delayed diagnosis and mainly the time interval between perforation and surgery.