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  • Chronic small intestinal dysmotility presenting as jejunal diverticulosis with refractory malabsorption: role for partial enterectomy?

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Chronic small intestinal dysmotility presenting as jejunal diverticulosis with refractory malabsorption: role for partial enterectomy?
  1. Lucas Wauters1,2,
  2. Mathias Clarysse2,3,
  3. Ina Jochmans2,3,
  4. Diethard Monbaliu2,3,
  5. Laurens J Ceulemans2,4,
  6. Astrid Verbiest2,
  7. Marc Miserez5,
  8. Nathalie Lauwers2,
  9. Wendy Nys2,
  10. Nelle Pauwels2,
  11. Martin Hiele1,2,
  12. Jacques Pirenne2,3,
  13. Tim Vanuytsel1,2
  1. 1 Department of Gastroenterology and Hepatology, Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
  2. 2 Leuven Intestinal Failure and Transplantation (LIFT), Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
  3. 3 Abdominal Transplant Surgery, Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
  4. 4 Thoracic Surgery, Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
  5. 5 Abdominal Surgery, Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
  1. Correspondence to Dr Tim Vanuytsel, Department of Gastroenterology and Hepatology, KU Leuven University Hospitals Leuven, Leuven 3000, Belgium; tim.vanuytsel{at}med.kuleuven.be

https://doi.org/10.1136/gutjnl-2021-324385

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    We read with interest the guidelines on the management of adult patients with severe chronic small intestinal dysmotility by Nightingale et al.1 Enteric myopathies can indeed manifest as jejunal diverticulosis, either acquired or congenital.2 Besides asymptomatic or acute complicated cases, chronic malabsorption due to bacterial overgrowth is a possible presentation of jejunal diverticulosis.3 As stated in the guidelines, this mechanism may lead to malnutrition or even intestinal failure.1 Although surgical options (resection, bypass or stoma formation) were discussed for pseudo-obstruction, resection of diverticula is usually not considered, as surgical outcomes of treatment-refractory cases have been rarely reported.

    We report here on our experience with a small series of patients with documented and refractory malabsorption due to small bowel diverticulosis who underwent partial enterectomy at the Leuven Intestinal Failure and Transplantation Centre (Leuven, Belgium) after consent. Bacterial overgrowth, steatorrhoea and medical treatment, including home parenteral nutrition (PN), were assessed. Median (range) time to referral and surgery, …

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    Footnotes

    • Contributors LW: acquisition of data, analysis and interpretation of data, drafting of the manuscript. MC: acquisition of data, analysis and interpretation of data, revision of the manuscript. IJ, DM, LJC, AV, MM, NL, WN, NP, MH and JP: acquisition of data, revision of the manuscript. TV: acquisition of data, analysis and interpretation of data, drafting of the manuscript, study supervision.

    • Funding LW and TV are supported by the Flanders Research Foundation (FWO Vlaanderen) through a doctoral fellowship (1190619N) and senior clinical research mandate (1830517N), respectively. MC is supported by a C3 grant (C32/18/035) from KU Leuven, Leuven, Belgium.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.