Harold H. Scudamore

Diverticctlosis of the Small Intestine and Macrocytic Anemia with Report of Two Cases and Studies on Absorption of Radioactive Vitamis B12

The syndrome of diverticulosis of the small intestine associated with macrocytic anemia, with or without steatorrhea and other malabsorptive defects, is apparently rather rare since reports of only 19 cases could be found in the literature.1-17 Jejunal diverticulosis also may be used in defining this syndrome since all patients had diverticula of the jejunum although, in addition, some had diverticula in the duodenum, ileum, esophagus, stomach, colon or urinary bladder. In 5 cases complications or previous operative procedures might have contributed toward the production of the macrocytic anemia and steatorrhea. These included partial gastrectomy,!5 regional enteritis with ileal stenosis,!1 ileocolic fistula,14 resection of 2 feet of terminal ileum and anastomosis leaving a blind pouch of ascending colon,12. 13 and intermittent obstructive jaundice, apparently owing to pressure on the common bile duct by one of the diverticula. 17 The bone marrow ,vas studied in 16 patients and was found to be megaloblastic in 15. Subacute combined degeneration of the spinal cord, peripheral neuropathy, glossitis, histamine-fast achlorhydria, and icterus have been reported in some of the patients with this syndrome. Liver extract or vitamin B12 administered parenterally has been found effective in the treatment of the anemia. The similarity between the anemia associated with jejunal diverticulosis and pernicious anemia raises the question of coincident pernicious anemia. Such a coincidence can be excluded in most instances by the presence of free hydrochloric acid in the gastric secretion (in 10 of 16 tested) and the presence of steatorrhea (noted in 12 cases recorded). Badenoch, Bedford and Evans6 reported also that at necropsy the gastric mucosa was not characteristic of that usually seen in pernicious anemia in 2 cases. Pernicious anemia could not be excluded positively in 2 of the cases.1, 10 The chance association of jejunal diverticulosis and nontropical sprue must be considered in the cases with associated steatorrhea. However, this association seems unlikely since the steatorrhea in the reported cases was mild, the onset of diarrhea was usually sudden, it occurred when the patient was elderly and was accompanied by symptoms of partial intestinal obstruction, a deficiency pattern

Limitations of the I131-Labeled Triolein Tests in the Diagnosis of Steatorrhea

Summary The I 131 -labeled triolein urinary excretion and fecal excretion tests for steatorrhea were evaluated in 36 patients with steatorrhea proven by chemical analysis of the feces for fat, and in an additional 28 patients who served as controls. The 24-hour urinary excretion test was found to be insensitive. The fecal excretion test was uniformly positive in patients with severe steatorrhea but was unreliable in patients with mild and moderate impairment of fat absorption. Because I 131 -labeled triolein provides only an insensitive and empiric index of fat absorption, its usefulness in clinical and physiologic studies seems limited.