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Small Intestine Diverticula - Causes
Last reviewed: 06.07.2025
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The causes and pathogenesis of duodenal diverticula are basically the same as those of other locations in the digestive tract. However, it should be taken into account, firstly, that in diseases such as peptic ulcer, duodenal dyskinesia, cholelithiasis (especially with frequent attacks of biliary colic), and other diseases of the digestive system, especially with a combination of several of them, the frequency of duodenal diverticula increases significantly. Secondly, it also increases with age, especially after 60-70 years and older. The combination of these two main listed factors gives the highest frequency of detection of duodenal diverticula.
Most duodenal diverticula are localized on its inner wall. In some cases, the occurrence of a duodenal diverticulum is facilitated by the presence of a focus (or foci) of heterotopia (inclusion in the intestinal wall) of pancreatic or fatty tissue. Relatively often, duodenal diverticula appear near the large papilla of the duodenum (the ampulla of Vater), which, when the diverticulum is overfilled with contents (with a narrow neck), as well as with diverticulitis, creates a risk of compression of the distal part of the common bile and pancreatic ducts with the development of corresponding complications: delayed secretion of bile into the duodenum, hyperbilirubinemia, jaundice of the subhepatic ("mechanical") type, cholangitis, pancreatitis, etc.
The literature devoted to this issue describes individual cases of the formation of a “diverticulum within a diverticulum” (i.e. a “daughter” diverticulum within a “parent” one).
Among duodenal diverticula, in addition to congenital and acquired, true and false, there are also “functional” diverticula of the duodenum (and esophagus), which are determined only during an X-ray examination with a barium sulfate suspension - as temporary bulges of the wall during the passage of the next portion of the contrast mass in this area.
The sizes of duodenal diverticula vary: from a few millimeters in diameter to 6-8 cm or more.
The causes of development and pathogenesis of small intestinal diverticula are not fully understood. In some cases, they are a congenital anomaly, developing in the weakest areas of the intestinal wall, in others they are an acquired pathology. Such are pulsion and traction diverticula. Pulsion diverticula occur with dyskinesia and intestinal spasms, when areas of "relaxation" appear in areas adjacent to the spasmodic areas, which leads to bulging of the intestinal wall. With traction diverticula, the intestinal wall is displaced ("pulled") by an adhesion during the adhesive process, gradually forming a diverticulum. With multiple diverticula, their congenital nature is more likely. Anatomical "weakness" of the intestinal wall is of undoubted importance in the origin of diverticula, as evidenced by their more frequent detection in older people, who are characterized by involutional changes in connective tissue and muscle structures. Diverticula are predominantly localized on the side of the intestine from which the mesentery branches off, since in this area the muscular layer of the intestinal wall is thinner.
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