Initial Procedure

• open longitudinally with blunt ended scissors along the mesenteric border avoiding any obvious areas of tumour or perforation.

Tip perforation or heterotopic tissue a

- Planes of opening c c

Sample the surgical resection margins (a), body (b) and tip (c) of the diverticulum

Figure 4.4. Meckel's diverticulum - specimens.

• measurements:

- lengths and maximum diameter (cm) of the parts present - duodenum, jejunum, ileum, caecum, ascending colon, appendix.

- lengths (cm) of ischaemic, strictured or hose-pipe segments, intussusception.

- maximum dimensions (cm) of any perforation(s), ulcer(s), polyp(s) and tumour(s).

- distances (cm) of the abnormality from the proximal and distal resection limits.

• gently pack the bowel lumen with formalin-soaked lint and fix by immersion in 10% formalin for 48 hours.

Ischaemic perforation

Ischaemic perforation

Transverse section the surgical limits and the bowel to represent normality and any lesion that is present. Sample the mesenteric vessels

Figure 4.5. Small bowel ischaemia.

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