Management of Multiple Jejunal Diverticula Found During Laparotomy
Resection of the jejunal loop containing the diverticula is the recommended management for multiple jejunal diverticula found incidentally during laparotomy for hepatic resection. 1
Rationale for Surgical Management
Jejunal diverticula, though uncommon, can lead to significant complications when left untreated. According to the World Journal of Emergency Surgery guidelines, surgery is the preferred treatment for jejunal diverticulitis due to the high mortality and morbidity associated with the severity of potential complications 1.
Key Considerations:
- While asymptomatic jejunal diverticula may not always require intervention, multiple diverticula found at the mesenteric border represent a higher risk for future complications
- Incidental finding during an already open abdomen provides an opportunity for definitive management
- Resection eliminates the risk of future complications that would require emergency surgery
Potential Complications if Left Untreated
Jejunal diverticula can lead to several serious complications:
- Diverticulitis with risk of perforation
- Intestinal obstruction (due to volvulus or intussusception)
- Malabsorption due to bacterial overgrowth
- Hemorrhage
- Abscess formation 2, 3
Studies have shown that complications of jejunal diverticula occur in approximately 10-30% of patients, significantly increasing morbidity and mortality rates 4.
Surgical Approach
The recommended surgical procedure includes:
- Resection of the affected jejunal segment containing the diverticula
- Primary end-to-end anastomosis of the jejunum
- Thorough inspection of the remaining small bowel for additional diverticula
This approach is supported by multiple case reports showing excellent outcomes with primary resection 3, 5, 6.
Why Biopsy Alone is Insufficient
Biopsy alone (option A) would not address the underlying pathology and leaves the patient at risk for future complications. Jejunal diverticula can cause acute complications requiring emergency surgery with higher morbidity and mortality 3.
Why Postoperative Antibiotics Alone is Insufficient
Postoperative antibiotics without resection (option C) would be inadequate as a standalone treatment. While antibiotics may temporarily suppress bacterial overgrowth in diverticula, they do not provide definitive treatment. Research has shown that antibiotics alone often fail to provide prolonged relief of symptoms in patients with multiple jejunal diverticula 2.
Special Considerations
- In hemodynamically unstable patients, damage control surgery might be considered with delayed definitive management
- If the diverticula involve a substantial portion of the jejunum, care must be taken to preserve adequate bowel length to prevent short bowel syndrome
Conclusion
Based on the World Journal of Emergency Surgery guidelines and supporting research evidence, resection of the jejunal loop containing the diverticula with primary anastomosis is the optimal management strategy for multiple jejunal diverticula found incidentally during laparotomy 1, 3. This approach eliminates the risk of future complications and provides definitive treatment.