Management of Jejunal Diverticulitis Found at Laparotomy
A. Resection and anastomosis is the correct answer—intestinal resection with primary anastomosis is the best surgical option for jejunal diverticulitis in stable patients. 1
Rationale for Resection and Anastomosis
Surgery is the preferred treatment for jejuno-ileal diverticulitis because of the high mortality and morbidity related to the severity of the disease. 1 Once you have already performed a laparotomy and confirmed mesenteric jejunal diverticulitis, the appropriate definitive management is resection with primary anastomosis rather than simply taking a biopsy.
Key Management Principles
Intestinal resection with anastomosis is the best surgical option in hemodynamically stable patients with jejunal diverticulitis who have already undergone laparotomy. 1
The high mortality rate associated with jejunal diverticulitis (particularly when complicated) necessitates definitive surgical treatment rather than conservative measures once the abdomen is open. 2, 3
Biopsy alone would be inadequate because it does not address the source of infection or prevent progression to perforation and peritonitis. 4
Clinical Decision Algorithm
For stable patients:
- Perform segmental jejunal resection with end-to-end primary anastomosis. 2, 4
- This approach provides definitive treatment and excellent outcomes when performed promptly. 4
For unstable patients with shock or generalized fecal peritonitis:
- Consider intestinal resection with stoma creation instead of primary anastomosis to minimize operative time and avoid poor outcomes. 1
- This damage control approach is reserved for hemodynamically unstable patients or those with significant physiological derangement. 5
Why Not Biopsy?
- Biopsy does not provide source control for the infection. 1
- Jejunal diverticulitis carries risk of imminent perforation and acute peritonitis, requiring definitive surgical management. 4
- The diagnosis is typically confirmed by imaging preoperatively or by direct visualization at laparotomy—histopathologic confirmation via biopsy is not necessary for management decisions. 2, 4
Common Pitfalls to Avoid
- Do not underestimate the severity: Jejunal diverticulitis has higher complication rates than colonic diverticulitis and requires aggressive surgical management. 3
- Do not delay definitive surgery: Once laparotomy is performed and diverticulitis is confirmed, proceeding with resection prevents progression to life-threatening complications. 2, 4
- Assess hemodynamic stability carefully: The choice between primary anastomosis versus resection with stoma depends critically on patient stability and presence of fecal peritonitis. 1