Artificial intelligence in jejunal diverticulosis: emerging applications in imaging recognition, risk stratification and surgical decision support
DOI:
https://doi.org/10.18203/2349-2902.isj20262497Keywords:
Jejunal diverticulosis, Artificial intelligence, Machine learning, Capsule endoscopy, CT enterography, Small bowel imaging, Diverticulitis, Risk stratification, Surgical decision support, RadiomicsAbstract
Jejunal diverticulosis is a rare small-bowel disorder that is frequently under-recognized and may present with severe complications including diverticulitis, perforation, haemorrhage, and intestinal obstruction. Diagnosis relies primarily on cross-sectional imaging, particularly computed tomography (CT) and CT enterography, yet diverticula are often overlooked due to their subtle appearance and the rarity of the disease. In parallel, artificial intelligence (AI) has rapidly advanced across gastrointestinal imaging and clinical decision support, offering new opportunities for automated lesion detection, imaging phenotyping, and risk prediction. Aim of the study was to review current and emerging applications of artificial intelligence relevant to jejunal diverticulosis, with emphasis on imaging recognition, complication risk stratification, and surgical decision support. A structured narrative review was conducted using a literature search informed by the PRISMA framework. Electronic databases including PubMed/MEDLINE, Scopus, and Google Scholar were searched for studies published between January 2000 and February 2026. Search terms included combinations of “jejunal diverticulosis,” “small bowel diverticula,” “artificial intelligence,” “machine learning,” “deep learning,” “capsule endoscopy,” “CT enterography,” and “diverticulitis.” Studies describing AI applications in capsule endoscopy, cross-sectional small-bowel imaging, diverticular disease, and surgical decision support were included. Findings were synthesized narratively due to heterogeneity in study design and methodologies. AI has demonstrated high diagnostic accuracy in gastrointestinal imaging, particularly in capsule endoscopy where convolutional neural networks can detect small-bowel lesions, including diverticula, with very high sensitivity and specificity. In cross-sectional imaging, machine-learning and radiomics models applied to CT enterography can identify and quantify small-bowel pathology and predict clinically relevant outcomes. AI applications in colonic diverticulitis and acute abdominal CT have shown promising performance in differentiating disease entities, predicting complications, and guiding clinical triage. These advances provide a methodological foundation for applying AI to jejunal diverticulosis. Potential applications include automated detection of jejunal diverticula on CT or CT enterography, multimodal risk stratification models integrating clinical and imaging data, and AI-assisted decision support for conservative versus surgical management. Although AI models specifically targeting jejunal diverticulosis have not yet been reported, advances in gastrointestinal imaging analytics and clinical prediction models suggest substantial potential for future development. Multi-institutional data sharing, standardized imaging annotation, and prospective validation studies will be essential to develop reliable AI tools capable of improving early detection, risk assessment, and surgical decision-making in this rare but clinically significant condition.
References
Al-Juhani A, Alzaki AA, Maghrabi EF, Rambo R, AlGhamdi A, Alanazi NA, et al. Artificial Intelligence-Assisted Capsule Endoscopy for Obscure Small-Bowel Bleeding: A Systematic Review of Workflow Gains and the Unmeasured Impact on Patient-Centred Outcomes. Cureus. 17(11):e96037.
Betz E, Hofmann K, Dubs L, Šandera P, Solimene F. Jejunal diverticulosis: complications and management – a case series. J Surg Case Rep. 2025;2025(7):rjaf569.
Alam S, Rana A, Pervez R. Jejunal diverticulitis: imaging to management. Ann Saudi Med. 2014;34(1):87-90.
Andour H, Loubaris S, Zahi H, Imrani K, Nassar I, Billah NM. Jejunal diverticulosis: A rare diagnosis with serious complications. Radiol Case Rep. 2025;20(1):556-9.
Chiorescu S, Mocan M, Santa ME, Mihăileanu F, Chiorescu RM. Acute complicated jejunum diverticulitis: a case report with a short literature review. Front Med. 2024;11.
De Peuter B, Box I, Vanheste R, Dymarkowski S. Small-bowel Diverticulosis:Imaging Findings and Review of Three Cases. Gastroenterol Res Pract. 2009;2009:549853.
Ding Z, Shi H, Zhang H, Meng L, Fan M, Han C, et al. Gastroenterologist-Level Identification of Small-Bowel Diseases and Normal Variants by Capsule Endoscopy Using a Deep-Learning Model. Gastroenterology. 2019;157(4):1044-54.
Aoki K. A study of endotoxemia in ulcerative colitis and Crohn’s disease. II. Experimental study. Acta Med Okayama. 1978;32(3):207-16.
Klang E, Amitai MM, Lahat A, Yablecovitch D, Avidan B, Neuman S, et al. Capsule Endoscopy Validation of the Magnetic Enterography Global Score in Patients with Established Crohn’s Disease. J Crohns Colitis. 2018;12(3):313-20.
Gangwani MK, Priyanka F, Irfan O, Hasan F, Gilani J, Sadiq MW, et al. The role of artificial intelligence in gastroenterology: current perspectives and future directions—narrative review. Transl Gastroenterol Hepatol. 2026;11:28.
Ma Y, Zhu L, Cui B, Zhang F, Li H, Zhu J. Computed tomography enterography-based radiomics nomograms to predict inflammatory activity for ileocolonic Crohn’s disease: a preliminary single-center retrospective study. BMC Med Imaging. 2025;25:27.
Stidham RW, Enchakalody B, Wang SC, Su GL, Ross B, Al-Hawary M, et al. Artificial Intelligence for Quantifying Cumulative Small Bowel Disease Severity on CT-Enterography in Crohn’s Disease. Am J Gastroenterol. 2024;119(9):1885-93.
Cocca S, Pontillo G, Grande G, Conigliaro R. Artificial intelligence in detection of small bowel lesions and their bleeding risk: A new step forward. World J Gastroenterol. 2024;30(18):2482-4.
Ziegelmayer S, Reischl S, Havrda H, Gawlitza J, Graf M, Lenhart N, et al. Development and Validation of a Deep Learning Algorithm to Differentiate Colon Carcinoma From Acute Diverticulitis in Computed Tomography Images. JAMA Netw Open. 2023;6(1):e2253370.
Bhandari A. Revolutionizing Radiology With Artificial Intelligence. Cureus. 16(10):e72646.
Klang E, Freeman R, Levin MA, Soffer S, Barash Y, Lahat A. Machine Learning Model for Outcome Prediction of Patients Suffering from Acute Diverticulitis Arriving at the Emergency Department—A Proof of Concept Study. Diagnostics. 2021;11(11):2102.
Thornblade LW, Flum DR, Flaxman AD. Predicting Future Elective Colon Resection for Diverticulitis Using Patterns of Health Care Utilization. EGEMS (Wash DC). 2018;6(1):1
Oh S, Ryu J, Shin HJ, Song JH, Son SY, Hur H, et al. Deep learning using computed tomography to identify high-risk patients for acute small bowel obstruction: development and validation of a prediction model : a retrospective cohort study. Int J Surg Lond Engl. 2023;109(12):4091-100.
Brejnebøl MW, Nielsen YW, Taubmann O, Eibenberger E, Müller FC. Artificial Intelligence based detection of pneumoperitoneum on CT scans in patients presenting with acute abdominal pain: A clinical diagnostic test accuracy study. Eur J Radiol. 2022;150:110216.
Luitel P, Shrestha BM, Adhikari S, Kandel BP, Lakhey PJ. Incidental finding of jejunal diverticula during laparotomy for suspected adhesive small bowel obstruction: A case report. Int J Surg Case Rep. 2021;85:106268.
Pouli S, Kozana A, Papakitsou I, Daskalogiannaki M, Raissaki M. Gastrointestinal perforation: clinical and MDCT clues for identification of aetiology. Insights Imaging. 2020;11:31.
Majtner T, Brodersen JB, Herp J, Kjeldsen J, Halling ML, Jensen MD. A deep learning framework for autonomous detection and classification of Crohnʼs disease lesions in the small bowel and colon with capsule endoscopy. Endosc Int Open. 2021;9(9):E1361-70.
Khan M, Arshad R, Malik I, Kamran A, Gul F, Lee KY. Jejunal diverticulosis presenting as intestinal obstruction—A case report of a rare association. Clin Case Rep. 2023;11(3):e7033.
Romeo S, Neri B, Mossa M, Riccioni ME, Scucchi L, Sena G, et al. Diagnostic yield of small bowel capsule endoscopy in obscure gastrointestinal bleeding: a real-world prospective study. Intern Emerg Med. 2022;17(2):349-58.
Abdulrasak M, Makitan M, Wurm Johansson G, Nemeth A, Koulaouzidis A, Toth E. An unforgettable diagnostic journey: multimodal evaluation of jejunal diverticulitis mimicking Crohn’s disease. Endoscopy. 2025;57(Suppl 1):E1411-2.
Chung D. Jejunal diverticulosis - A case series and literature review. Ann Med Surg. 2022;75:103477.
Shi Q, Hao Y, Liu H, Liu X, Yan W, Mao J, et al. Computed tomography enterography radiomics and machine learning for identification of Crohn’s disease. BMC Med Imaging. 2024;24:302.
Abdelhalim D, Kania T, Heldreth A, Champion N, Mukherjee I. Operative Management of Perforated Jejunal Diverticulitis. Cureus. 14(1):e21330.
Hunter J, Vaidya H, Crowe S, Utley M, King Z, Li K, et al. Development of a machine learning model to predict intensive care unit bed demand for adult elective surgical patients at a large United Kingdom National Health Service Trust. BJA Open. 2026;17:100513.
Baqar S, Hamed AS, Elbreki I, Mohamed T, Awan B, Elsaigh M, et al. The Role of Artificial Intelligence and Machine Learning Applications in Emergency Surgery: A Systematic Review of Diagnostic Accuracy and Clinical Outcomes. Cureus. 2025;17(6):e85386.
Clement David-Olawade A, Olawade DB, Vanderbloemen L, Rotifa OB, Fidelis SC, Egbon E, et al. AI-Driven Advances in Low-Dose Imaging and Enhancement—A Review. Diagnostics. 2025;15(6):689.
Simsar M, Yuruk YY, Sahin O, Sahin H. Radiological insights into diverticulitis: Clinical manifestations, complications, and differential diagnosis. World J Radiol. 2025;17(8):107463.
Zhang XY, Hu MD, Maimaitijiang D, Wang T, Wang L. Artificial intelligence in pancreatitis: A narrative review on advancing precision diagnosis, prognosis, and therapeutic strategies. World J Gastroenterol. 2025;31(39):110971.
Abbas Q, Jeong W, Lee SW. Explainable AI in Clinical Decision Support Systems: A Meta-Analysis of Methods, Applications, and Usability Challenges. Healthcare. 2025;13(17):2154.
Kattenborn T, Leitloff J, Schiefer F, Hinz S. Review on Convolutional Neural Networks (CNN) in vegetation remote sensing. ISPRS J Photogramm Remote Sens. 2021;173:24-49.
Xu W, Fu YL, Zhu D. ResNet and its application to medical image processing: Research progress and challenges. Comput Methods Programs Biomed. 2023;240:107660.
Zakaria N, Hassim YMM. A Review Study of the Visual Geometry Group Approaches for Image Classification. J Appl Sci Technol Comput. 2024;1(1):14-28.
Ramos LT, Sappa AD. A Decade of You Only Look Once (YOLO) for Object Detection: A Review. IEEE Access. 2025;13:192747-192794.
Ronneberger O, Fischer P, Brox T. U-Net: Convolutional Networks for Biomedical Image Segmentation. In: Navab N, Hornegger J, Wells WM, Frangi AF, eds. Medical Image Computing and Computer-Assisted Intervention – MICCAI 2015. Springer International Publishing; 2015:234-241.
Salman HA, Kalakech A, Steiti A. Random Forest Algorithm Overview. Babylon J Mach Learn. 2024;2024:69-79.
Mammone A, Turchi M, Cristianini N. Support vector machines. WIREs Comput Stat. 2009;1(3):283-9.
Zhang Z, Wu J, Wang J, Chen Y, Yao R, Zhu L, et al. Extreme gradient boosting-based explainable machine learning model for predicting significant fibrosis in autoimmune hepatitis. QJM Int J Med. 2026;119(1):34-41.
Ridwan AMd, Mohi Uddin KM. Explainable machine learning for early diagnosis of esophageal cancer: A feature-enriched Light Gradient Boosting Machine framework with Shapley Additive Explanations and Local Interpretable Model-Agnostic Explanations interpretations. J Int Med Res. 2026;54(1):03000605251411752.
Hussain MA, Waris MA, Akram MU, Khan MJ, Asaf MZ, Javaid A, et al. ViT-Stain: Vision transformer-driven virtual staining for skin histopathology via global contextual learning. PLOS ONE. 2026;21(2):e0341311.
Arshad H, Lopez-Ramirez F, Tixier F, Soyer P, Kawamoto S, Fishman EK, et al. Radiomics in Early Detection of Pancreatic Ductal Adenocarcinoma: A Close Look at Its Current Status and Challenges to Clinical Implementation. Can Assoc Radiol J. 2026;77(1):107-18.
Pan Z. Letter to the Editor: Technical considerations in the development of a multimodal deep learning model for predicting hepatocellular carcinoma outcomes. Hepatology. 2026;83(2):E86.
Uttarwar M, Khandare J, Shivamurthy PM, Satpute A, Panwar M, Kothavade H, et al. A Clinically Translatable Multimodal Deep Learning Model for HRD Detection from Histopathology Images. Diagnostics. 2026;16(2):356.
Gismondi M, Ali OH, Ajao O, Dastur J. Jejunal Diverticulosis Presenting With Small Bowel Obstruction: A Diagnostic Challenge. Cureus. 2024;16(3):e56205.
Hamza HM, Malik MM, Khan NU, Tariq MD, Awan AA, Rai D. Jejunal diverticulosis causing intestinal obstruction in a middle-aged man: a rare case emphasizing coexistence and potential association with colorectal carcinoma. Ann Med Surg. 2025;88(1):804-8.
Ibrahim AHM, Amer N, Alatooq HH, AlQatari AA, Abdulmomen AA. Jejunal diverticulosis: A case report. Int J Surg Case Rep. 2023;104:107946.
Ilangovan R, Burling D, George A, Gupta A, Marshall M, Taylor SA. CT enterography: review of technique and practical tips. Br J Radiol. 2012;85(1015):876-86.
Spada C, Piccirelli S, Hassan C, Ferrari C, Toth E, González-Suárez B, et al. AI-assisted capsule endoscopy reading in suspected small bowel bleeding: a multicentre prospective study. Lancet Digit Health. 2024;6(5):e345-53.
Kwon YS, Park TY, Kim SE, Park Y, Lee JG, Lee SP, et al. Deep learning-based localization and lesion detection in capsule endoscopy for patients with suspected small-bowel bleeding. World J Gastroenterol. 2025;31(27):106819.
Mascarenhas Saraiva M, Ribeiro T, Afonso J, Ferreira JPS, Cardoso H, Andrade P, et al. Artificial Intelligence and Capsule Endoscopy: Automatic Detection of Small Bowel Blood Content Using a Convolutional Neural Network. GE Port J Gastroenterol. 2021;29(5):331-8.
Wasnik AP, Al-Hawary MM, Enchakalody B, Wang SC, Su GL, Stidham RW. Machine learning methods in automated detection of CT enterography findings in Crohn’s disease: A feasibility study. Clin Imaging. 2024;113:110231.
Rice J, Ó’Briain E, Kilkenny CJ, Hogan RE, McIntyre TV, Kavanagh D, et al. Assessing Artificial Intelligence as a Diagnostic Support Tool for Surgical Admissions in the Emergency Department. J Surg Educ. 2025;82(10):103676.
Jamil M, Li Q. Artificial intelligence in gastrointestinal endoscopy: current evidence and future directions. Ther Adv Gastrointest Endosc. 2025;18:26317745251398945.
Kröner PT, Engels MM, Glicksberg BS, Johnson KW, Mzaik O, van Hooft JE, et al. Artificial intelligence in gastroenterology: A state-of-the-art review. World J Gastroenterol. 2021;27(40):6794-824.
Kumar D, Meenakshi. Complicated jejunal diverticulitis with unusual presentation. Radiol Case Rep. 2018;13(1):58-64.
Lamb R, Kahlon A, Sukumar S, Layton B. Small bowel diverticulosis: imaging appearances, complications, and pitfalls. Clin Radiol. 2022;77(4):264-73.
Loftus TJ, Altieri MS, Balch JA, Abbott KL, Choi J, Marwaha JS, et al. Artificial Intelligence-enabled Decision Support in Surgery: State-of-the-art and Future Directions. Ann Surg. 2023;278(1):51-8.
Murtada A, Bokobza De la Rosa MD, Kayali F, Mensah A, Majid S, Ghattas SNS, et al. Can Artificial Intelligence Revolutionise Surgical Decision-Making for Appendectomy? A Narrative Review. Surg Innov. 2025;33(2):15533506251393123.
Mortimer A, Harding J, Roach H, Callaway M, Virjee J. Jejunal diverticulitis: an unusual cause of an intra-abdominal abscess - coronal Computed Tomography reconstruction can aid the diagnosis. J Radiol Case Rep. 2008;2(5):15-8.
Ponce Beti MS, Palacios Huatuco RM, Picco S, Capra AE, Perussia DG, Suizer AM. Complicated jejunal diverticulosis with intestinal perforation and obstruction: delay in hospital visit during confinement due to COVID-19. J Surg Case Rep. 2022;2022(2):rjac010.
Sarıtaş AG, Topal U, Eray İC, Dalcı K, Akçamı AT, Erdoğan K. Jejunal diverticulosis complicated with perforation: A rare acute abdomen etiology. Int J Surg Case Rep. 2019;63:101-3.
Scheese D, Alwatari Y, Khan J, Slaughter A. Complicated jejunal diverticulitis: A case report and review of literature. Clin Case Rep. 2022;10(11):e6570.
Sogunro OA, Buck M, Labrias PR. Jejunal diverticulitis: three case reports of a rare but clinically significant disease. Dig Med Res. 2021;4(10).
Wang X, Wang X, Lei J, Rong C, Zheng X, Li S, et al. Machine Learning Models Based on CT Enterography for Differentiating Between Ulcerative Colitis and Colonic Crohn’s Disease Using Intestinal Wall, Mesenteric Fat, and Visceral Fat Features. Acad Radiol. 2025;32(10):5860-8.