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Acquired diverticular -false diverticular -lack muscularis -incidence increase by age 1.duodenum/near ampulla -more common -periampullary/juxtapapillary/ peri vaterian diver -75% medial wall 2.jejunalileal diverti -80%--jejunum--large/multiple 15%--ileum--small/solitary Pathophysio -abnor of intes smooth m or dysregulate motility -asso bact overgrowth :b12 def/megaloblastic/malabsorpt Clinical -asymp unless asso c/p--inci 6-10% :intes obstruct/diverticulitis/hmg perforate/malabsorpt -periampullary duodenal diver :cholangitis/stone/pancreatitis Dx -incidental on imaging/endo/sx -enteroclysis--most sen for jeju-ileal Tx 1.Asymptom--no sx 2.C/p -jejunoileal--segmental resection -duodenal--diverticulectomy Bleeding duodenal diver -lat duodenotomy+oversewn
Meckel diverticulum Rule of 2 2% prevelence 2:1 f:m 2 foot prox IC valve 2yr 2 heterotopic muco--gastric/pancreas Meckel at inguinal/femoral hernia -Littre hernia Pathophysio -fail of vitelline duct obliterate -vitelline a remnant--mesodiver band smb obstruction 1.volvulus around band 2.mesodiver band 3.intussusception 4.stricture--chronic diverticulitis Clinical asymp unless c/p--incidence rate4-6% 1.bleeding--most common of child 2.intes obstr--most common of adult 3.diverticulitis--as appendicitis Dx -CT--not good -enteroclysis--good but not in c/p -scan--if have ectopic mucosa Tx Symp meckel diverticula -diverticulectomy -remove band Bleeding/perforate -segmental resecsection Incidental finding -controversy -against prophylactic sx of asymp -some--selective (have band/narrow base) I/C for incidental diverticulectomy 1.<18 year 2.sign of previous diverticulitis 3.mesodiverticular band 4.palapble heterotopic tissue
Adenoma in FAP -aggressive tx -if possible--removed endoscopic -if sx require--PD :multiple/sessile lesion :periampullar region -surveillance :f/u in 6 mo and q 1yr if no recur Jejunal/ileum ca -wide-local excision -regional lymphadenectomy -local advance,metas :palliative resection or bypass -CMT no proven efficacy in adjuvant or palliative tx of small b.adenoca