Small bowel diverticulosis: imaging appearances, complications, and pitfalls

Misdiagnosis of pancreatic intraductal papillary mucinous neoplasms and the challenge of mimicking lesions: imaging diagnosis and differentiation strategies

The rising prevalence of pancreatic cystic lesions (PCLs), particularly intraductal papillary neoplasms (IPMNs), has been attributed to increased utilization of advanced imaging techniques. Incidental detection of PCLs is frequent in abdominal CT and MRI scans, with IPMNs representing a significant portion of these lesions. Surveillance of IPMNs is recommended due to their malignant potential; however, their overlapping imaging features with benign entities can lead to misdiagnosis, overtreatment, and overutilization of healthcare resources. This paper aims to highlight and differentiate lesions often mistaken for IPMNs, providing insight into their imaging characteristics, diagnostic challenges, and distinctive features while highlighting the incidence of wrong diagnosis for these lesions. These lesions include serous cystadenomas, cystic pancreatic neuroendocrine tumors, mucinous cystic neoplasms, lymphoepithelial cysts, duodenal diverticula, pancreatic schwannomas, chronic pancreatitis, retention cysts, intrapancreatic accessory spleens, pancreatic lipomas, choledochal cysts, and others. Utilizing various imaging modalities, including contrast-enhanced CT, MRI, and EUS, alongside histological and molecular analyses, can aid in accurate diagnosis and appropriate management. Understanding these mimicry scenarios is crucial to avoid unnecessary surveillance, interventions, and the burden they place on both patients and healthcare systems. Improved recognition of these lesions can lead to better patient outcomes and resource allocation.

A Case of Uncomplicated Duodenal Diverticulosis Presenting With Right Upper Abdominal Pain

Small bowel diverticulosis is not a common disease entity; however, it is increasingly diagnosed and linked to various gastrointestinal complaints. Although rare, complications can occur and may sometimes require surgical or endoscopic intervention. Furthermore, suspecting and diagnosing duodenal diverticulosis (DD) can be challenging due to the variety of presenting signs and symptoms. Much of our current knowledge comes from case reports and series. This report aims to document a case of DD presenting with severe right upper quadrant pain mimicking the signs and symptoms of acute cholecystitis. It also reviews and summarizes the available literature on the clinical manifestations of DD, its diagnostic approach, treatment modalities, and possible complications encountered in the ED.

Small Bowel Diverticulosis and COVID-19: Awareness Is the Key: A Case Series and Review of the Literature

Small bowel non-Meckelian diverticulosis is a rare condition with only a few published cases despite being described over 200 years ago. In the midst of the COVID-19 pandemic, studies suggested that many patients may experience gastrointestinal manifestations. Intestinal symptoms could worsen the inflammation and infection associated with small bowel diverticulitis. Here we present three cases: one with inflammation and rupture in a COVID-19 patient and another as an asymptomatic detection. The third case involved recurrence after the first laparoscopic lavage approach. Furthermore, we provide a mini-review of the literature to emphasize the importance of considering this entity in the differential diagnosis of an acute abdomen. In the majority of cases involving small bowel diverticula, conservative management is the preferred approach. However, when complications arise, surgical intervention, including enteroctomy and primary anastomosis, may be necessary to achieve optimal outcomes.

Acute abdomen following axial torsion of a Giant Meckel's diverticulum in a young male: A case report

Introduction and importance

Among Meckel's diverticulum (MD), the ‘Giant’ category is relatively rare. Most Giant MDs lead to complications such as torsion and diverticulitis.

Presentation of case

A 20-year-old South Asian male presented with a three-day history of vomiting and left-sided abdominal pain. X-ray and ultrasound scan of the abdomen illustrated features of small bowel obstruction. He underwent laparotomy under general anaesthesia. A gangrenous, axially torsed 25-cm Giant MD with concurrent ileal compression by a mesodiverticular band was detected and diverticulectomy and segmental resection with end-to-end anastomosis of the ileum was performed. Histology revealed ectopic gastric and pancreatic tissue. He had an uneventful postoperative stay and was devoid of any surgery-related complications at one-year follow-up.

Clinical discussion

Adults mainly present with bowel obstruction following complicated MDs. Multiple mechanisms have been elaborated as causalities of bowel obstruction where the presence of bands of congenital or inflammatory origin, intussusception, and enteroliths are relatively common. The presence of ectopic tissue in MDs is associated with increased complications. Symptomatic MDs need resection to abate future complications such as haemorrhage and obstruction.

Conclusion

Despite the low diagnostic potential of clinical examination and radiological studies, a high degree of suspicion is warranted in cases of probable MD-resultant complications, where more common aetiologies have been ruled out, as delay in diagnosis and definitive surgical therapy are invariably associated with worsened morbidity and mortality. It is high time to elucidate related demographics and clinical data on Giant MDs to identify high-risk categories and develop safer follow-up protocols.

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Giant Meckel's diverticulum (MD) is a rare entity.

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Complications such as torsion and diverticulitis are common complications of Giant MDs.

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Basic radiological studies lack sensitivity and specificity in detecting MDs.

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High degree of clinical suspicion is warranted whenever symptomatic MD is a probable diagnosis.

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Early surgical intervention with laparotomy or laparoscopy leads to favourable outcomes.

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Comprehensive data on Giant MDs are a necessity.