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Diverticular Disease of the Stomach and Small Bowel

by Michael C. DiMarino, MD

Diverticula rarely involve the stomach but occur in the duodenum in up to 25% of people. Most duodenal diverticula are solitary and occur in the second portion of the duodenum near the ampulla of Vater (periampullary). Jejunal diverticula occur in about 0.26% of patients and are more common among patients with disorders of intestinal motility. Meckel diverticulum occurs in the distal ileum.

Duodenal and jejunal diverticula are asymptomatic in > 90% of cases and are usually detected incidentally during radiologic or endoscopic investigation of the upper GI tract for an unrelated disease. Rarely, small-bowel diverticula bleed or become inflamed, causing pain and nausea. Some even perforate. For poorly understood reasons, patients with periampullary diverticula are at increased risk of gallstones and pancreatitis. Treatment is surgical resection; however, the clinician should be cautious of recommending surgery for patients with a diverticulum and vague GI symptoms (eg, dyspepsia).

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