Chapter 19. Small Intestine
Stricturoplasty is indicated in a Crohn patient with:
A. Fistula at the level of the stricture
B. Intra-abdominal abscess
C. Multiple areas of stenosis
D. Multiple intestinal fistulas
Indications for stricturoplasty include the maintenance of intestinal length after previous resection or the identification of single/multiple strictures in diffusely involved bowel.
Contraindications include the presence of intestinal fistulas or intra-abdominal abscess.
A Heineke-Mikulicz stricturoplasty can be performed for strictures <12 cm in length, a Finney stricturoplasty can be performed for strictures up to 25 cm in length, and a side-to-side isoperistaltic enteroenterostomy can be used for strictures up to 50 cm in length.
How do adults with Meckel diverticulum usually present?
The most common presentation of Meckel diverticula in adults is intestinal obstruction. Obstruction from a Meckel diverticulum occurs in various ways such as intussusception with the diverticulum as the lead point, stricture from chronic diverticulitis, intestinal entrapment by a mesodiverticular band, and volvulus of the intestine around a fibrous band connecting the diverticulum to the umbilicus.
The most common presentation of a Meckel diverticulum in children is bleeding.
Which of the following forms of calcium supplementation should be administered to gastric bypass patients?
Calcium citrate is the supplementation of choice for patients with low acid exposure.
Which of the following is the FIRST to recover from postoperative ileus?
D. The stomach, small intestine, and colon recover from ileus simultaneously
Small intestine recovers within 24 hours after laparotomy, the stomach recovers by 48 hours, and the colon recovers within 3 to 5 days.
You perform exploratory surgery on a 35-year-old male for presumed appendicitis. The terminal ileum is identified and noted to be edematous, inflamed, and beefy red. The cecum and appendix are normal in appearance. What should you do?
A. Abort the procedure and close
B. Perform an ileocecectomy with end ileostomy
C. Perform a right hemicolectomy