Due to the nonspecific presentation associated with small bowel diverticula and their associated complications, the differential includes but is not limited to pancreatitis, cholecystitis, cholangitis, peptic ulcer disease, gastroenteritis and bowel obstruction.

The diagnosis of small bowel diverticular disease and subsequent development of diverticulitis is often challenging. As with all presentations, a thorough history and physical examination is essential. Signs and symptoms may include nausea, vomiting, abdominal pain, fever and chills. Radiologic studies including plain abdominal films and ultrasound may be helpful in excluding other differential diagnoses. A CT scan of the abdomen is the imaging modality of choice for small bowel diverticulitis and may demonstrate thickening of the bowel wall and surrounding fat inflammation. In the presence of a perforation, extraluminal air or the extravasation of contrast may be visualized. In cases which CT imaging is not able to identify the etiology of a patient’s symptoms, additional studies include esophagogastroduodenoscopy, endoscopic retrograde cholangiopancreatography, fluoroscopic upper gastrointestinal swallow study, or small bowel follow-through may be utilized [1].

Small bowel diverticula may lead to complications consistent with inflammation, obstruction or hemorrhage. The incidence of these complications ranges from 6 to 10%. Inflammation consistent with diverticulitis may lead to perforation or bleeding, posteriorly into the retroperitoneal space and anteriorly into the peritoneal space or aorta. Mortality associated with complicated small bowel diverticulitis is reported to be as high as 40%.