From the Research
The management of multiple jejunal diverticula discovered incidentally during laparotomy for hepatic resection should be conservative observation with postoperative antibiotics if the diverticula are asymptomatic. This approach is based on the most recent and highest quality study available, which emphasizes the importance of conservative management for asymptomatic diverticula 1. The key points to consider in this management approach include:
- Most jejunal diverticula are asymptomatic and do not require surgical intervention unless they are actively causing complications such as bleeding, perforation, obstruction, or malabsorption.
- Resection of the affected loop would be unnecessarily aggressive for an incidental finding and carries additional surgical risks.
- Biopsy is not indicated as the diagnosis can be made visually, and sampling could potentially cause complications.
- Prophylactic antibiotics covering enteric flora should be administered postoperatively, typically including a combination of a third-generation cephalosporin and metronidazole for 3-5 days.
- The conservative approach acknowledges that jejunal diverticula are relatively common, occurring in 1-2% of the population, and most remain clinically silent throughout life.
- Surgical intervention should be reserved only for cases with clear evidence of diverticular complications, as supported by studies such as 2 and 1. It is essential to prioritize a conservative approach to minimize morbidity, mortality, and improve quality of life for patients with asymptomatic jejunal diverticula discovered incidentally during laparotomy for hepatic resection.