Types of small bowel diverticuli:
(1) congenital and true (muscularis propria present) - Merkel's diverticulum
(2) acquired and false (no muscularis propria) - may occur anywhere in small intestine
Symptoms associated with diverticuli:
(1) none (asymptomatic)
(2) chronic abdominal pain, often postprandial
(3) abdominal distention
(4) weight loss
(5) nausea and vomiting after meals
(6) diarrhea
(7) malabsorption with steatorrhea
(8) rupture with abscess or peritonitis
(9) acute or chronic gastrointestinal bleeding
(10) intestinal obstruction
Indications for surgery:
(1) chronic intractable symptoms
(2) acute complications
(3) Merkel's diverticulum found incidentally during another procedure
Incidental small bowel diverticuli that were asymptomatic were not resected.
Surgical guidelines:
(1) An asymptomatic Merkel's diverticulum is resected by wedge resection of the diverticulum.
(2) If perforation is the reason for surgery, then the segment of small bowel with the perforated diverticulum is resected and an end-to-end anastomosis is performed.
(3) If the site of perforation cannot be demonstrated after a careful examination and the disease is extensive, then resection should not be performed.
(4) Oversewing or other closure of a perforated diverticulum is not acceptable management.
(5) If surgery is being performed for chronic symptoms, then the extent of the diverticular disease should be determined prior to surgery. Short segment or moderate disease should be resected. Extensive disease should be discussed carefully to determine optimum management.
