75 year old woman complains of diarrhea of about 6 month duration, fever for one month, abdominal pain and leukocytosis. The colonoscopy showed normal results. A CT scan showed wall thickening of distal ileal loops with thickened terminal ileum, with hypodense submucosal fat (fat halo sign). A Crohn type inflammatory bowel disease with involvement of distal ileal loops was indicated.
Enteroclysis showed a large number of diverticula, which affected the entire small bowel, a few centimetres away from the ileocecal valve. It also showed separation of close loops, probably due to thickening of the meso and loss of mucosal pattern with small ulcerative type images. There were also findings consistent with a nonspecific inflammatory bowel disease. The patient became asymptomatic with medical treatment.
Small bowel diverticula are rare entities whose prevalence in autopsies ranges between 0.06% and 1.3% and in less than 2% of these cases they are a massive diverticulosis of the small bowel. That is the reason why it might be underdiagnosed.