Small-Bowel Surgery

Before biologics, exclude intestinal TB (colonoscopic biopsy, AFB stain, TB-PCR/GeneXpert, chest CT, IGRA). For limited non-stricturing terminal ileitis, offer early laparoscopic ileocecal resection alongside infliximab (LIR!C trial), using a Kono-S antimesenteric anastomosis when resected. Manage enterocutaneous fistula with the SNAP protocol — Sepsis control, Nutrition, Anatomy mapping, Planned delayed reconstruction after >=6–12 weeks.

Before: Empiric anti-TNF biologic therapy without excluding Mycobacterium tuberculosis, or immediate early laparotomy (<6 weeks) for postoperative enterocutaneous fistula.

Now: Before biologics, exclude intestinal TB (colonoscopic biopsy, AFB stain, TB-PCR/GeneXpert, chest CT, IGRA). For limited non-stricturing terminal ileitis, offer early laparoscopic ileocecal resection alongside infliximab (LIR!C trial), using a Kono-S antimesenteric anastomosis when resected. Manage enterocutaneous fistula with the SNAP protocol — Sepsis control, Nutrition, Anatomy mapping, Planned delayed reconstruction after >=6–12 weeks.

Patients with ileocecal Crohn's disease in whom intestinal tuberculosis is a differential (and any patient being considered for anti-TNF therapy), and patients with postoperative enterocutaneous fistula, exactly as the addendum's summary row states them.

The TB-exclusion step prevents disseminated TB activation in endemic regions — it is a safety gate, not an optional workup. In ECF, deferring definitive takedown until obliterative peritoneal inflammation subsides (>6 weeks) halves recurrent fistula and mortality rates; the printed reconstruction window is >=6–12 weeks.

• ECCO-ESCP Crohn's Surgery Guidelines — as cited in the addendum summary table (no PMID printed)
• LIR!C Trial (Lancet Gastroenterol Hepatol) — as cited in the addendum summary table (no PMID printed)
• ASCRS Enterocutaneous Fistula Guidelines — as cited in the addendum summary table (no PMID printed)

Symptomatic Meckel's (bleeding, diverticulitis, intussusception, obstruction): segmental ileal resection or wide wedge diverticulectomy removing both the diverticulum (ectopic gastric mucosa) and the adjacent ulcerated mesenteric-border ileal mucosa. Incidental Meckel's: selective diverticulectomy when >=1 risk factor is present (the printed list includes a narrow neck, a fibrous band, and palpable heterotopic tissue).

Before: Simple narrow-base amputation in bleeding Meckel's diverticulum, leaving adjacent ulcerated ileal mucosa — or routine resection of every incidental Meckel's in frail older adults.

Now: Symptomatic Meckel's (bleeding, diverticulitis, intussusception, obstruction): segmental ileal resection or wide wedge diverticulectomy removing both the diverticulum (ectopic gastric mucosa) and the adjacent ulcerated mesenteric-border ileal mucosa. Incidental Meckel's: selective diverticulectomy when >=1 risk factor is present (the printed list includes a narrow neck, a fibrous band, and palpable heterotopic tissue).

Patients with symptomatic Meckel's diverticulum and patients in whom a Meckel's diverticulum is found incidentally at laparoscopy or laparotomy, exactly as the addendum's summary row stratifies them.

In bleeding Meckel's, peptic ulceration occurs on the adjacent ileal wall rather than inside the acid-secreting diverticular tip — a narrow-base amputation leaves the bleeding source behind. Selective incidental resection avoids morbidity in low-risk older adults. Source-text note: the row's printed risk-factor list contains a clipped fragment ('age 2 cm' — comparison operators lost in the source DOCX); the card reproduces only the intact printed risk factors, and the fragment is recorded here and in CONVERSION-LOG.md for source repair rather than reconstructed.

• Park et al., Mayo Clinic 1,476-Patient Cohort (Ann Surg) — as cited in the addendum summary table (no PMID printed)
• Contemporary Acute GI Consensus — as cited in the addendum summary table (no PMID printed)