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PubMed2004

[Giant diverticulum of the sigmoid].

A 77-year-old woman who had been examined 8 months previously because of chronic abdominal pain and an altered pattern of defecation presented to the emergency department with complaints of nausea, vomiting and acute pain in the abdomen. Her appetite was diminished and she had lost 10 kg in the past year. The abdominal X-ray showed a balloon-like, gas-filled intra-abdominal configuration, which proved to be a giant diverticulum of the sigmoid. She was treated by resection of the diverticulum and the sigmoid. A giant diverticulum is a rare complication of diverticulosis, a frequently occurring condition that is encountered most often in the sigmoid; the complication can easily be missed. The presenting symptoms can vary from an acute abdomen to chronic non-specific abdominal complaints. The most important complications of a giant diverticulum are perforation, obstruction or a volvulus. In view of the severity of these complications, resection of that part of the intestine in which the giant diverticulum arises is the treatment of choice.

Abdominal Pain↗

PubMedDate not supplied

Meckel's diverticulum: a neglected (or deliberately ignored) entity.

Meckel's diverticulum is the most common of all the possible abnormalities that incomplete obliteration of the omphalo-mesenteric duct can produce. Often it is not sought during surgery performed for other abdominal diseases, e.g. cases of appendicitis. In these situations searching for and treating Meckel's diverticulum may be regarded as simply a waste of time or unjustified because its surgical treatment is not a completely safe procedure. In our opinion the systematic search for, and treatment of, Meckel's diverticulum during surgery performed for other abdominal conditions should always be performed. Elective resection of the diverticulum is characterised by fewer postoperative complications than emergency surgery. Laparoscopy would appear to be safe and effective in the treatment of this pathology, even in cases of severe diverticulitis. We report on our last five years' experience with the surgical treatment of this rare pathology, mainly occurring in previously appendectomised patients. One aim of this study was to demonstrate the possible benefits of the laparoscopic approach, focussing attention on the advisability of searching for and resecting Meckel's diverticulum when discovered incidentally during abdominal interventions performed for other pathologies.

Adolescent↗

PubMed1992

The treatment of pharyngoesophageal diverticulum: the simple and complex.

Over 900 patients have been treated at the Mayo Clinic for Zenker's diverticulum since 1944 using a one-stage transcervical diverticulectomy under general anesthesia. Overall results have been very good, but not entirely free of morbidity or mortality. An attempt is made to define those circumstances in which the procedures used have either been judgmentally or technically difficult or in which morbidity or mortality has occurred. These include patients with concomitant medical or surgical problems, or complexity related to the diverticulum itself. Among the latter are huge or giant sacs, patients with severe nutritional and respiratory symptoms related to aspiration, the perforated diverticulum, reoperation for recurrent diverticulum and cancer in a diverticulum.

Carcinoma, Squamous Cell↗

PubMed2006

Ulcer in the basis of Zenker's diverticulum mimicking esophageal malignancy.

Complications of Zenker's diverticulum are rare and include ulcer, bleeding and malignancy. Ulcer in the basis of diverticulum is a very rare complication and to date only four cases have been reported in the literature. Herein, we report a new case of ulcer in Zenker's diverticulum mimicking esophageal malignancy presumed to be due to aspirin and/or alcohol consumption. The exact diagnosis was troublesome and needed to perform diagnostic procedures repeatedly. The patient underwent external pharyngoesophageal diverticulectomy. We emphasize that endoscope should be withdrawn if any resistance is encountered during esophageal intubation-even with forward-viewing endoscope-especially when there is a Zenker's diverticulum suspicion and the patient receives ulcerogenic agents. Endoscopic examination should be performed prior to any definitive surgical procedure in all patients with Zenker's diverticulum.

Aged↗

PubMed1990

[Meckel's diverticulum---clinical picture, diagnosis and treatment].

Meckel's diverticulum is the most common anomaly of the gastrointestinal tract. It is usually asymptomatic, but it can cause rectal bleeding and bowel obstruction in both children and adults. Different investigative methods are used to diagnose Meckel's diverticulum. When a Meckel's diverticulum is suspected to cause rectal bleeding in children, the first choice of examination is the Meckel scan. Angiography is an alternative method in adults. Demonstration of a Meckel's diverticulum using barium meal examination is rare, but enteroclysis has been stated to be the most accurate method in detecting Meckel's diverticulum and other focal abnormalities of the small bowel.

Diagnosis, Differential↗

PubMed1986

[Gastric diverticulum invaded by carcinoma].

Diverticulum of the gastric body is uncommon and the coexistence of this lesion and gastric carcinoma much more. The authors report a case of diverticulum and carcinoma of the gastric body in a 66-year-old woman. The partially resected stomach exhibited a diverticulum, 3 X 3 X 2 cm in size, on the lesser curvature and a carcinoma of the depressed type on the posterior wall. The latter was IIc + III-like advanced carcinoma showing poor differentiation histologically and partly invading the diverticular wall, which had no muscular layer (i.e., pseudo-diverticulum). As for pseudodiverticulum, carcinoma cells invading the submucosa will reach the serosa easily. It is important not to overlook carcinomas in or around the diverticulum.

Adenocarcinoma↗

PubMed1988

Siblings with left ventricular diverticulum and hypertrophic cardiomyopathy.

This report describes very rare siblings who had a left ventricular muscular diverticulum and hypertrophic cardiomyopathy. The first case is a 16-year-old male. On two-dimensional echocardiography, a left ventricular muscular diverticulum in the posterior wall and mitral valve prolapse were detected. The former was verified by left ventriculography. Endomyocardial biopsy showed findings compatible with hypertrophic cardiomyopathy. The second case is a 13-year-old female. Two-dimensional echocardiography revealed a left ventricular muscular diverticulum in the same location as that of the first case, and mitral valve prolapse as well. The former was confirmed by left ventriculography. The endomyocardial biopsy findings were compatible with hypertrophic cardiomyopathy. The coronary angiograms were normal in both cases. To our knowledge, familial appearance of a left ventricular diverticulum has not yet been reported, and a left ventricular diverticulum at the posterior wall in cases with hypertrophic cardiomyopathy is very rare.

Adolescent↗

PubMed1985

[Two cases of giant vesical diverticulum in females].

Two rare cases of giant vesical diverticulum without infravesical obstruction in female are presented. The first case, a 58-year-old female, was admitted because of diverticulum with continuous urinary infection, which was diagnosed by urological examinations for hematuria. The second case, a 58-year-old female, was admitted with the diagnosis of diverticulum, which was done by the gynecologist during laparotomy for the suspicion of a right ovarian cyst. Neither patient complained of difficulty in urination in spite of remarkable residual urine and no neurologic abnormalities were detected. The cystograms of the two cases revealed over-goose-egg sized diverticula and vesical capacity was over 800 ml, in both cases. The other urograms and endoscopy showed no evidence of vesical trabeculation or any obstructive changes of bladder neck or urethra in either case. Therefore, mucosal diverticulectomy in the first and total diverticulectomy in the second, was performed for the residual urine. Each surgical specimen showed the muscle layer of the walls. In the post-operative course, urination was improved in spite of the underactive detrusor pattern of the cystometry in the first case. But residual urine volume was not decreased after the operation in the second case. These two cases seem to be congenital vesical diverticulum. But it is hard to rule out the possibility of secondary diverticulum due to neurogenic disorders of urinary bladder.

Cystoscopy↗

PubMed1977

Solitary diverticulum of the caecum and its complications.

Solitary diverticulum of the caecum is very rare and assumes clinical interest only when inflamed. Preoperatively the condition is virtually impossible to distinguish from acute appendicitis, and even during operation its differentiation from carcinoma is difficult. It is also important to determine whether or not an underlying solitary diverticulum of the caecum is present. In the present series the symptoms and clinical examination as well as laboratory findings pointed to acute appendicitis, which was in fact the preoperative diagnosis in all our patients. In one case the operative findings were strongly suggestive of carcinoma, which was only excluded by inspection and histological examination of the specimen. The wall of the diverticulum was necrotic in all cases. It had already perforated in the previously mentioned case, and right hemicolectomy was performed. An inflamed, but recognizable, solitary diverticulum of the caecum was treated by excision, but the tumour-like mass produced by the diverticulum was removed by resection. In view of the considerable possibility of underlying carcinoma, the authors support an aggressive trend in the treatment of "inflammatory tumours" of the caecal wall.

Adult↗

PubMedDate not supplied

[Giant diverticulum of the sigmoid].

This reports a rare case of diverticulum of the sigmoid in a 73 years old patient, which presence was detected about 4 years before surgery. This giant diverticulum manifested itself mainly through pain followed by anorexia. On X-ray it had the appearance of a gas cyst. The pathogeny of such a diverticulum is to be found in inflammatory factors at the base of implantation; it results from pressure effects in the diverticulum with the probable action of anaerobic bacterial fermentation. The pathologic examination does not always allow differenciation between a giant diverticulum and a duplication, especially where the later communicates with the digestive tract. The indications and surgical techniques are discussed.

Aged↗

PubMed1995

Giant sigmoid diverticulum.

The case of a giant diverticulum of the sigmoid colon in a 74 year-old woman is reported. The diverticulum had perforated into the urinary bladder and required a 3-phase operation with resection of the sigmoid colon and urinary bladder. Giant diverticulum is considered a rare complication of diverticulosis. Generally, it is a pseudo-diverticulum that grows due to a valve mechanism working in the neck of the diverticulum. The differential diagnosis lies mainly between intestinal duplication and pneumatosis cystoides. Surgical therapy yields favorable results.

Aged↗

PubMed1995

[Meckel's diverticulum in children].

In 1978-1988 operations were performed on 92 children: 35 with diverticulitis, 7 with intestinal intussusception, 5 with hemorrhage from an ulcer of the diverticulum, 13 with strangulation or mechanical ileus, 2 with strangulated Littre's hernia, one with torsion of the omentum, 22 with secondary diverticulitis, and in 7 children Meckel's diverticulum was a chance finding during other operations in the cavities. Boys accounted for 60.9' (56) of cases. There were 12 children under one year of age, nine from 1 to 3 years, 17 from 3 to 5 years, 17 from 5 to 7 years, and 12 children aged from 7 to 10 years. The clinical manifestations depended on the pathological changes developing in Meckel's diverticulum. A clinical picture of acute appendicitis developed in diverticulitis, six children had a typical picture of intussusception, and one child had a picture of acute abdomen. Anemia and a stool with dark blood were encountered in hemorrhage from a diverticular ulcer. Seven out of 13 children with ileus had a pronounced clinical picture, in the remaining 5 it was unclear and resembled that of acute appendicitis. Meckel's diverticulum was suspected before the operation in 17 (9.95%) patients. The Volkovich-Dyakonov laparotomy approach was used in 64 children, a pararectal incision in 9, a transrectal incision in 15, a median incision in one patient, hernio-laparotomy was conducted in one and Shpizi's operation in 2 children. Diverticulectomy was accomplished by the oblique-transverse method in 79 children, by the wedge techniques in 5, by the purse-string method in 2 patients, and resection of the intestine with the diverticulum was conducted in 5 children.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗

PubMed1994

[Three operated cases of epiphrenic esophageal diverticulum].

Three cases of epiphrenic esophageal diverticulum, treated successfully by surgery, were reported. Case 1 was a 71-year-old female associated with gastroesophageal reflux and esophageal dysmotility. Case 2 was a 40-year-old female associated with gastroesophageal reflux but no esophageal dysmotility. Case 3 was a 51-year-old male who showed no abnormality in esophageal pH and manometry, and esophageal scintigraphy. Resection of the diverticulum was performed in three cases and Belsey's fundoplication was added in case 1 and 2. In the patients with epiphrenic diverticulum, concomitant esophageal dysfunction can be the cause of the diverticulum and symptom. It is essential in deciding the surgical procedure to evaluate the esophageal function in the patients with epiphrenic esophageal diverticulum.

Adult↗

PubMed1994

[Meckel's diverticulum. Personal experience].

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, occurring in 1-3% of autoptic studies. It's remnant of the omphalomesenteric duct which connects the primitive gut to the yolk sac in early fetal life and the failure of obliteration may result in an omphalomesenteric fistula, an enterocyst, a fibrous band connecting the small intestine to he umbilicus. It's a true diverticulum arising from the antimesenteric border of the small bowel and often is associated with inflammatory bowel disease. Usually Meckel's diverticulum is asymptomatic; when it's complicated by bleeding, obstruction and inflammation, occurs as a symptomatic lesion but it's difficult to diagnose, because its signs and symptoms are identical to such common as Crhon's disease, appendicitis, and peptic ulcer diseases. The preoperative diagnosis of a Meckel's diverticulum, especially in the adult when asymptomatic, is still a serious problem; X-ray, US, radioisotopic scan and TAC are noninvasive, nonspecific test for the detection of this lesion. Many authors had suggested (to prevent its complications), the routine search during every laparotomy, with its surgical resection also in asymptomatic cases. The authors report their fifteen years experience in the diagnosis and treatment of 29 cases of patients with Meckel's diverticulum in the Susa Hospital (1976-1991).

Adolescent↗

PubMed1994

Preoperative diagnosis of Meckel's diverticulum by pertechnetate scan and laparoscopic resection.

Acute lower gastrointestinal hemorrhage in a 17-year-old boy was caused by a Meckel's diverticulum 1 day after ingestion of 500 mg acetylsalicylic acid. After conservative treatment of the bleeding, the diverticulum was diagnosed in the free interval by technetium pertechnetate scintigraphy, which showed an accumulation in the right lower quadrant simultaneously with the accumulation in the gastric mucosa. Elective explorative laparoscopy confirmed the diverticulum, and the resection was performed by laparoscopic means. Histology showed gastric-type mucosa in the diverticulum. The treatment of choice for Meckel's diverticulum, when it is diagnosed preoperatively or during laparoscopy, is laparoscopic resection.

Adolescent↗

PubMed1975

Intraluminal duodenal diverticulum. Report of two cases and review of the literature.

Diverticula rarely occur within the lumen of the duodenum. They arise near the papilla of Vater and extend distally. The diverticulum is lined on both sides with duodenal mucosa, and its eccentric opening is usually proximal in the sac. The diverticulum results from incomplete recanalization of the intestinal lumen after the proliferative epithelial stage in the 7-week embryo and represents either a remnant of one of two channels formed during recanalization or a distal ballooning of a congenital duodenal diaphragm. Although the patient with a diverticulum may be asymptomatic, most patients present with abdominal pain and obstructive symptoms; pancreatitis and gastrointestinal bleeding may be associated with the diverticulum. Barium study shows a characteristic radiolucent halo that represents the wall of the diverticulum. Surgery should be approached with caution because injury to the papilla is a hazard, and in children, coexisting congenital anomalies may be present.

Adult↗

PubMed1993

Heterotopic gastric mucosa and Helicobacter pylori infection in Meckel's diverticulum in Indian subjects.

Two of twenty nine (6.8%) patients who had undergone resection of Meckel's diverticulum demonstrated heterotopic gastric mucosa. In both these patients gastric mucosa was of antral type. Remaining 27 of 29 (93.2%) patients with Meckel's diverticulum had intestinal mucosa. 9 of 29 (31%) patients with Meckel's resected were symptomatic (8 bleeding, 1 perforation) and all 9 were negative for heterotopic gastric mucosa. Helicobacter pylori (H. pylori) was absent in both patients with intestinal mucosa. Antral biopsy from 13 partial gastrectomy specimens (surgery done for carcinoma stomach) were used as methodological controls and 7 of 13 (54%) showed H. pylori colonization. We conclude that (i) incidence of gastric mucosa is 6.8% in Meckel's diverticulum in our population, (ii) presence of heterotopic gastric mucosa is unlikely to be associated with complications of Meckel's diverticulum and (iii) heterotopic mucosa in Meckel's diverticulum is not commonly colonized by H. pylori.

Adolescent↗

PubMed1993

[A case of isolated congenital left ventricular diverticulum].

Isolated congenital diverticulum of the left ventricle is a rare malformation. A 2-year-old boy was admitted to our hospital for evaluation of heart murmur. The echocardiogram and MRI showed an extra cavity communicating with the left ventricle. The diagnosis was made by LV angiography. He was diagnosed as having congenital isolated diverticulum of the left ventricle without other cardiac anomalies. He received resection of the diverticulum under cardiopulmonary bypass. Histological examination showed a fibrous diverticulum. Postoperative clinical course was uneventful. We can expect good prognosis after resection of the congenital diverticulum of the left ventricle, if necessary under cardiopulmonary bypass.

Child, Preschool↗