الفهرس 
EmbrologyOnly 14 pages are availabe for public view
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Abstract
-There are three varities of small intestine diverticulosis: Duodenal diverticulosis, Jejunal and ileal diverticula and Meckel’s diverticulum.
-Apart from Meckel’s diverticulum duodenal diverticula are the second most common form of enteric diverticula after divbrticulosis of the colon followed by jejunum, ileum, sto-mach, and oesophagus.
-Duodenal diverticula occur in latter decades of life with a preponderance in female they are of 2 types :
A) Intraluminal type also named intraluminal cyst, duodenal
septum , windosck web, congenital diaphragm. It is a rare congenital disorder, usually located in the
second portion of the duodenum, in close ploximity to the ampulla, within the lumen extending distally like the •thumb of the glove” and it is lined by mucosa on
both surfaces. It develops between the 4th and 8th week of the embryo’s life , but it increases in size during adult life. It usually presents with typical
or atypical symptoms of peptic ulcer disease, but sometimes manifestations such as gastrointestinal bleeding, duodenal obstruction or pancreatitis may predominate and may be severe and life, threatening
B) Extraluminal diverticula : Outpouching of the mucous membrane through a spot of lowered resistance in the duodenal wall (Locus minoris resistantiae) which may be created by either the passage of the biliary, pan-creatic ducts, blood vessels through the wall of the duodenum, congenital absence of an adequate muscle coat or by heterotopic pancceatic tissue. 62% of duodenal diverticula are found in the second portion of the duodenum, 30% are found in the 3rd portion and 8% are located in the fourth portion of the duodenum. Diverticula of the lst part may result from stenosis or traction from scar tissue . Duodenal diverticula
may be associated with other disease e.g., peptic ulcer, gallbladder ds., hiatus hernia, diverticulosis of colon or stomach and pancreatic diseases. There is no pathog-nomonic symptoms, but vague abdominal complaints simul-ating gallbladder diseases, peptic ulcer syndrome
dyspepsia or by complication as inflammation, absess formation, perforation haemorrhage, and pancreatitis.
- Preoperative diagnosis is invariably based on upper gast-rointestinal barium meal series, hypotonic duodenography (especially in the intraluminal verity) , flourscopy and fibre-optic duodenoscopy.
Medical treatment usually suffice in the majority of cases presenting with vague upper abdominal symptoms which are diverticulum dependent. Surgical treatment is indicated
if they are symptomatizing or complicated . There is no definite surgical treatment if asymptomatic diverticula are accidentally discovered during surgery for unrelated condition. Excision of the diverticulum is the best type of surgery.
Diverticulosis of jejunum and ileum : They are considered
to be an asymptomatic condition, but they may produce a variety of interesting clinical and pathophysiologic synd-romes which are correctable by surgical intervention-. It
is a rare condition with an incidence of 0.57%.The proximal jejunum is the most frequent site of involvementothe large diverticula are found near the duodeno-jejunal flexure. They pouch through the intestinal wall on its mesenteric border. A case of intraluminal jejunal diver-
ticulum is reported. Non specific symptoms like vague dys-pepsia, post prandial discomfort or subacute intestinal obstruction may occur but usually the diagnosis of div-erticulosis is late . Medical treatment is the treatment of choice especially for chronic complications as blind loop syndrome (Vit. B12 malabsorption with megaloblastic anaemia and steatorrhea). Surgery is restricted for com-
plicated cases resection of the segment bearing diverticula and end-to-end anastomosis.
- Meckel’s diverticulum : It occurs relatively frequently and has been clamed by some to be the commonest anomaly of the gastrointestinal tract. This congenital abnromality is due to incomplete obliteration of the omphalomesenteric
duct. It differs than other diverticula of the small intes-tine by being formed by all the layers of the muscularis
of the small intestine. Incidence varies from 1 % to 2.5 % with prepondenance in males. Site of origin is between
15 and 90 cm from the caecum at the antimesenteric border. The lining of Meckel’s diverticulum in 20% represents het-erotopic tissue e.g. gastric mucosa 15% pancreatic tissue 5% and other as duodenal and colonic mucosa singly or in com-bination. Serious complications may develop and pose a threat to life. It is a potential source of danger to the patient and should be excised, even when it appears to be nromal during an exploratory laparotomy. When complicated
it presents with either bleeding per rectum, peritonitis, intestinal obstructions,dyspepsia, umbilical sinus . There are three methods for removing a Meckel’s diverticulum :
1)By a wedge shaped resection of the ileum containing the diverticulum.
2)Resection of a segment of ileum containing the diver-ticulom.
- Five cases are reported, two of them are due to duodenal diverticula (one presented with haematemesis and the other with dyspepsia).
Two other cases are due to Meckel’s diverticulum (one presented with intestinal obstruction due to intnssusaption and the other presented with per-forated peptic ulcer in Meckel’s diverticulum).
The fifth case are due to jejunal diverticulosis presented with dyspepsia.