Surgery for Michael's Diverticulum

The occurrence of the distal ileum diverticulum is the result of incomplete closure of the yolk tract in the embryonic stage, with the proximal end remaining and communicating with the ileum. Most of the sites are located at the end of the ileum 40 to 90 cm from the ileocecal valve. The shape is various, the base size is different, and the intestinal wall is mostly protruded from the side wall of the mesentery such as a bag or a finger, and some of the cord is connected with the umbilicus at the top end, which is a factor causing the cord to compress the intestinal obstruction. The inside of the sputum often has a fascinating gastric mucosa or pancreatic tissue, which may cause ulceration, bleeding or perforation. Treatment of diseases: jejunum, ileal diverticulum colonic diverticulosis Indication Surgical treatment should be promptly performed when complications such as diverticulitis, intestinal obstruction, hemorrhage or perforation occur in the diverticulum. If other diseases are laparotomy, if an asymptomatic diverticulum is found, it should generally be removed. Except when the child is in poor condition. In particular, if the diverticulum is large or the diverticulum is more likely to have complications, it should be removed. Preoperative preparation Prepare accordingly according to different complications. Such as the correction of hemorrhagic anemia, the treatment of fluid imbalance and electrolyte imbalance caused by intestinal obstruction. Surgical procedure 1. Incision: The right rectus abdominis incision can be used to extend upward and downward with the umbilical plane as the center. It can also be used to make a transverse incision under the umbilicus or to make a clear diagnosis of the right lower abdomen McBurney incision. 2. After the laparotomy, the ileum was explored from the ileocecal area to the near side. After the diverticulum was found, different resection methods were used according to different pathological findings. When the diameter of the diverticulum base is smaller than the diameter of the intestine, and the tissue is not thickened by inflammatory edema, two vascular clamps are used, and the base of the diverticulum is clamped horizontally or obliquely, and the diverticulum is removed between the two clamps. After the stump mucosa was wiped with iodine and ethanol, a 2-0 silk thread was used for suture stitching or continuous full-layer suture under the vascular clamp. The additional muscle layer is sutured. Some authors use diverticulum residual pouch sutures to treat the diverticulum, which is easy to cause intestinal stenosis and should not be promoted. 3. The diverticulum base is wide, the diameter is larger than the intestinal lumen, or the diverticulum has inflammation, thickening or bleeding, perforation, can be used for the wedge resection of the basal intestine, that is, the craniocerebral forceps and the intestine vertical wedge clamp The intestinal wall of the diverticulum base, and then the diverticulum and part of the intestinal wall were removed between the two clamps. For example, closed suture, that is, the anterior suture of the sarcolemma layer of the transvascular clamp is performed from the side of the vascular clamp, and the vascular clamp is turned 180°, and the sarcolemma suture is made on the other side. Relax the vascular clamp and the sutures are knotted one by one. Complete the first layer of inversion suture, plus a second layer of muscle layer discontinuity or suture suture. Check that the anastomosis is unobstructed. If you do an open anastomosis, you should place a blocking forceps clamp before loosening the vascular clamp, taking care to avoid surgical contamination. If the diverticulum lesion invades the nearby intestinal wall, the anastomosis of the intestine should be performed. complication Intestinal leakage in the diverticulum resection site, causing intra-abdominal infection, requiring surgical treatment. Intestinal obstruction in the diverticulum resection site can be observed first without non-surgical treatment. If it can not be relieved, surgery is required.

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