What is the recommended management for multiple diverticula found at the mesenteric border of a jejunal loop during a laparotomy (surgical incision into the abdominal cavity) for hepatic (liver) resection?

Management of Jejunal Diverticula Found Incidentally During Laparotomy

Resection of the affected jejunal loop with primary end-to-end anastomosis is the recommended management for incidentally discovered jejunal diverticula during laparotomy to prevent future complications that could require emergency surgery. 1

Rationale for Resection

Jejunal diverticula are uncommon compared to colonic diverticula, with reported incidence varying from 0.05% to 6%. When found incidentally during surgery:

• Even asymptomatic jejunal diverticula warrant resection as they can lead to serious complications including:

  • Diverticulitis
  • Perforation
  • Hemorrhage
  • Intestinal obstruction
  • Bacterial overgrowth leading to malabsorption
  • Midgut volvulus (in rare cases) 2

• The World Journal of Emergency Surgery recommends resection of affected jejunal segments when found incidentally to prevent future complications that might require emergency surgery 1

Surgical Approach

The optimal surgical approach includes:

• Segmental resection of the affected jejunal loop containing the diverticula
• Primary end-to-end anastomosis
• In cases of extensive small bowel diverticulosis, resection should be limited to the segment with diverticula to avoid short bowel syndrome 1, 3

Why Antibiotics Alone Are Insufficient

While postoperative antibiotics may be used to suppress bacterial overgrowth, they do not provide definitive treatment:

• Antibiotics alone may provide temporary relief but often fail to provide prolonged symptom resolution 4
• The 1980 study by Digestive Diseases and Sciences reported a case where two courses of antibiotics failed to provide lasting relief, but surgical resection of the diverticula was curative 4

Why Biopsy Alone Is Inadequate

Simply performing a biopsy without resection is insufficient because:

• It does not address the potential for future complications
• Jejunal diverticula can lead to life-threatening complications requiring emergency surgery
• A 2008 study reported a case of ulcerative jejunal diverticulitis requiring emergency surgery due to imminent perforation 5

Special Considerations

• For elderly patients or those with significant comorbidities, carefully weigh the risks of extended operative time against the benefits of resection 1
• If the patient is hemodynamically unstable during the primary procedure, consider damage control surgery with a staged approach 1
• Ensure proper assessment of bowel viability before and after resection 1

Potential Complications if Left Untreated

Untreated jejunal diverticula can lead to:

• Acute intestinal obstruction 6
• Diverticular bleeding 3
• Perforation with mesenteric abscess 3
• Localized or generalized peritonitis 3
• Malabsorption due to bacterial overgrowth 4

The 2020 case report in the International Journal of Surgery Case Reports highlights how even a single jejunal diverticulum can cause serious complications like midgut volvulus and bowel ischemia 2.