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Jejunal Diverticulosis: Findings on CT in 28 Patients

¹ All authors: Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —87-year-old man with moderate jejunal diverticulosis on CT (not diagnosed prospectively) and marked jejunal diverticulosis on barium study. Axial contrast-enhanced CT image shows jejunal diverticula (representative diverticula denoted by white arrows) as multiple round, thin-walled structures with no recognizable folds. Note gas in nondependent portion and contrast material in dependent portion of several diverticula with air–contrast levels. One diverticulum (arrowhead) contains tiny gas bubbles and nonuniform contrast enhancement due to retained debris. Two duodenal diverticula (black arrows) are also seen.

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —87-year-old man with moderate jejunal diverticulosis on CT (not diagnosed prospectively) and marked jejunal diverticulosis on barium study. Overhead radiograph from early portion of small-bowel follow-through shows multiple large jejunal diverticula (white arrows). Also note large diverticula (black arrows) in second and third portions of duodenum.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —60-year-old man with abdominal pain and bloating after meals. Axial contrast-enhanced CT images show multiple large (1–3 cm in diameter) diverticula (white arrows) in jejunum and proximal ileum that were not diagnosed prospectively. Pneumatosis in one diverticulum is manifested by linear intramural gas (arrowhead, A) inferiorly in relation to dependent portion of contrast-filled lumen. Also note tiny droplets of gas in adjacent small-bowel mesentery (black arrow, A).

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —60-year-old man with abdominal pain and bloating after meals. Axial contrast-enhanced CT images show multiple large (1–3 cm in diameter) diverticula (white arrows) in jejunum and proximal ileum that were not diagnosed prospectively. Pneumatosis in one diverticulum is manifested by linear intramural gas (arrowhead, A) inferiorly in relation to dependent portion of contrast-filled lumen. Also note tiny droplets of gas in adjacent small-bowel mesentery (black arrow, A).

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —60-year-old man with abdominal pain and bloating after meals. Spot radiograph from enteroclysis shows numerous large diverticula in jejunal and proximal ileum as round, barium-filled sacs (arrows). Note how diverticula can be distinguished from adjacent loops of small bowel by absence of small-bowel folds. This patient's symptoms resolved after treatment of bacterial overgrowth syndrome with antibiotics.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —Axial contrast-enhanced CT image in 75-year-old woman shows single jejunal diverticulum as 7-mm ovoid gas collection with barely discernible wall (arrowhead) abutting contrast-filled loop of jejunum (arrow). This tiny diverticulum was recognized by scrolling through contiguous image slices. Patient had additional diverticula that were identified prospectively on other images.

View larger version (133K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —Axial CT image in 76-year-old woman shows bilobed gas-filled structure with air–fluid level inferiorly. Scrolling of images identified diverticulum as structure with air–fluid level (arrow) and small-bowel lumen as gas-containing structure (arrowhead), with narrowing of diverticular neck where it arises from adjacent loop. Jejunal diverticulosis was not diagnosed prospectively on CT in this patient.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —Axial CT image in 55-year-old man with abdominal pain shows diverticula (black arrows) in jejunum. Also note band of increased attenuation (white arrows) and tiny gas bubbles (arrowhead) in small-bowel mesentery due to presumed jejunal diverticulitis that was diagnosed prospectively in this patient.

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