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PubMedDate not supplied

Intrabiliary pressure measurement by duodenal pressure loading for the evaluation of duodenal parapapillary diverticulum.

BACKGROUND/AIMS: We report a method of intrabiliary pressure measurement by duodenal pressure loading for evaluating the effects of duodenal parapapillary diverticulum. MATERIAL AND METHODS: Forty-eight patients with primary choledocholithiasis were investigated based on usual intrabiliary pressure measurement developed at our department. RESULTS: Ten of these patients with parapapillary diverticulum showed higher intrabiliary residual pressure (P) and biliary resistance (R) values than the remaining patients without diverticulum, but the difference were not significant. There were no significant differences in the frequency of patterns of the B zone angulation of the pressure curve between the two groups with and without parapapillary diverticulum. Intrabiliary pressure was measured while maintaining a manometer pressure of 250 mm H2O by infusing or aspirating physiologic saline. CONCLUSION: From the results of this measurement for 6 patients, when P and R values show increases of 50 mm H2O or more and 3.5 units or more, respectively, additional surgery for parapapillary diverticulum was considered to be indicated.

Biliary Tract↗

PubMed1996

[Endoscopic surgery of bladder diverticulum].

OBJECTIVE: To assess the endoscopic treatment of a vesical diverticulum by incision of the diverticulum opening and mucous fulguration associated to infravesical deobstructive surgery. METHOD: The procedure was performed in 30 male patients with flowmetry-documented infravesical obstruction. Results were radiologically evaluated, with patients being assigned to one of 3 groups: diverticulum disappearance; size reduction greater than 50% and persistence or size reduction lower than 50%. RESULTS: Disappearance of diverticulum was verified in 15 patients, size reduction greater than 50% in 9 patients, and persistence or size reduction lower than 50% in 6 patients. The complications rate in this series was 6.6%. CONCLUSIONS: Endoscopic treatment of a vesical diverticulum with the technique used in our series, was shown to be effective, particularly in diverticula with diameter under 50 mm, and was associated to low morbidity and short hospital stay.

Adult↗

PubMedDate not supplied

[Surgical treatment of pharyngoesophageal or Zenker's diverticulum].

BACKGROUND: The different surgical approaches of Zenker's diverticulum are controversial. AIM: To analyze the results of the surgical management of Zenker's diverticulum. METHODS: The charts of patients with surgical treatment of Zenker's diverticulum were reviewed in a retrospective fashion. The demographic and clinical data, surgical indication and procedures, operative morbidity and mortality and results were analyzed. RESULTS: There were 15 patients, 12 men and 3 women with an average age of 68 years. All of them reported cervical dysphagia, 93 per cent regurgitation and 60 per cent upper airway symptoms. The barium esophageal study was diagnostic in all patients. Cricopharyngeal myotomy was performed in all patients and diverticulopexy (60 per cent) or diverticulectomy (40 per cent) was accomplished. There were one mucosal perforation during the myotomy but three esophageal fistula were developed during the first postoperative week. All three received medical treatment with healing between the 7th to 21st postoperative day. One patient suffered acute myocardial infarction and there were no deaths. During the follow-up in 14 patients (93.3 per cent) disappearance of symptoms were reported, in the remaining patient minimal dysphagia was present. CONCLUSIONS: The surgical treatment of Zenker's diverticulum should be performed in symptomatic patients. The esophageal X-ray study is the best diagnostic tool. The cricopharyngeal myotomy is the keystone in the surgical treatment and may be complete with inversion, diverticulectomy or diverticulopexy according with the physical and clinical characteristics of diverticulum and the patient. There were excellent results in more than 90 per cent of the operated patients, with a low morbidity and no mortality.

Aged↗

PubMedDate not supplied

[Meckel's diverticulum. Study of 61 cases].

BACKGROUND: Meckel's diverticulum is a well known disease in children. The main clinical presentations are rectal bleeding and intestinal occlusion. OBJECTIVE: To investigate the frequency, main clinical symptoms, signs, complications, localization, histology and diagnosis in a population of mexican children. METHOD: We studied 61 children who were seen at the Instituto Nacional de Pediatria, Mexico City, during a period of 10 years. The age, sex, symptoms, complications, hematocrit, 99mTc-Pertechnetate scanning, histology, and localization of Meckel's diverticulum were analyzed in all of them. RESULTS: 15 children were female and 46 male (1:3). In infants the main clinical finding was rectal bleeding. Intestinal occlusion was the most common clinical expression in older children. Gastric mucosa was a common finding in the diverticulum of children with rectal bleeding in contrast to ileal mucosa in children with intestinal occlusion. 99mTc-pertechnetate scanning with previous administration of H2 blocking agent was the best diagnostic procedure. CONCLUSIONS: Meckel's diverticulum must be considered an emergency in children. Meckel's diverticulum, has to be ruled cut as in infants with significant bleeding, as well as in children with intestinal occlusion. The best method for diagnosis is 99mTc-pertechnetate scanning.

Adolescent↗

PubMed1998

[Microsurgical laser treatment of Zenker's diverticulum. Economic aspects].

Zenker's diverticulum (hypopharyngeal/proximal oesophageal diverticulum/pouch) is a relatively uncommon cause of dysphagia usually in elderly patients. We describe the results of the first 10 patients operated for ZD with micro-endoscopic laserdiverticulotomy (LD), where the "spur" between the diverticulum and oesophagus is coagulated by means of a CO2 laser in our department. The results are compared with the results of the last nine patients operated with conventional diverticulectomy (DE) via incision on the neck. Two patients in the DE group had complications (wound infection and pneumonia), whereas no complications were seen in the LD group. An initially good result was seen in all the patients in both groups. Symptoms recurred in 11% in the DE group (one patient), whereas this was seen in 20% of the patients in the LD group (two patients). Re-operation of these two patients in the LD group relieved the patients of symptoms, but one patient was re-operated twice before this was achieved. Surgery time was reduced by 64%. Hospitalization time was shortened from a median of 16 (9-28) days with DE to 4 (0-9) days in the LD group. These factors represent a substantial economic saving by using LD as compared to DE. To be able to evaluate the result of LD roentgenographically, it has proven necessary to produce a pure lateral view of the diverticulum both pre- and post-operatively. The size and shape of the diverticulum is mostly seen as unchanged following surgery. With a pure lateral projection, it is however possible to see how the spur between the oesophagus and the diverticulum is diminished with resulting enhanced passage of contrast and practically no retention.

Aged↗

PubMed1997

[Endoscopic treatment of Zenker's diverticulum using CO2 laser. 17 cases].

OBJECTIVES: Various treatment regimens have been used for the management of Zenker's diverticulum. These include surgery (transcervical diverticulectomy, myotomy) and endoscopic treatment with rigid instruments or flexible endoscope. The aim of this study is to report the results of the treatment of Zenker's diverticulum with rigid endoscope applied CO2 laser and to compare them with other types of treatment. PATIENTS AND METHODS: Between May 1991 and November 1996, 17 patients (8 males, 9 females) with symptomatic Zenker's diverticulum underwent endoscopic treatment under short general anesthesia applied CO2 laser. The mean age of the patients was 73.2 years (range: 54 to 97 yrs). All patients had significant symptoms such as dysphagia (15 patients out of 17). All patients were clinically evaluated after the procedure. RESULTS: The endoscopic incision was performed in one session per patient. Symptoms and dysphagia disappeared in all patients except one (dysphagia). Two complications (one cervical emphysema, one fistula) were managed clinically. Mortality was 0%. Mean follow-up was 17 months. There was no recurrence of dysphagia, all patients remained asymptomatic. CONCLUSIONS: Rigid endoscopic treatment of symptomatic Zenker's diverticulum applied with laser CO2 is an efficient and safe method. It should be considered as an alternative therapy for Zenker's diverticulum, especially for patients at a high surgical risk.

Aged↗

PubMed1980

Carcinoma within a middle esophageal (parabronchial) diverticulum: a case report and the review of the literature.

A case of carcinoma developed in the middle esophageal (parabronchial) diverticulum is reported. In recent literature, 44 cases of carcinoma in esophageal diverticulum were reported. Most of the patients who had carcinoma in a diverticulum have a long-term history of symptom related to diverticula. Prognosis of these patients was poor because the carcinomas were far advanced when they were found. Therefore, the patient with esophageal diverticulum should be checked with esophagogram, esophagoscopy and biopsy, considering the possibility of development of carcinoma. Most of the cases of carcinoma in a diverticulum were treated with diverticulectomy. However, we consider that radical esophagectomy is a better method of treatment.

Aged↗

PubMed1984

Long-term survival following diverticulectomy for cancer in pharyngoesophageal (Zenker's) diverticulum.

The incidence of cancer in a pharyngoesophageal (Zenker's) diverticulum was 0.4% among 1,249 patients treated for such diverticula at the Mayo Clinic in a 53-year period. Twenty-four patients with squamous cell carcinoma arising in a pharyngoesophageal diverticulum have been reported by others. However, most of the patients died of the malignancy within 2 years of treatment, and there were no long-term survivors. We describe 2 long-term survivors who were without evidence of tumor or diverticulum recurrence 4 1/4 and 8 years after one-stage pharyngoesophageal diverticulectomy. Review of the literature revealed that most patients with cancer in pharyngoesophageal diverticulum should be managed in a manner similar to that for patients with ordinary cervical esophageal malignancy. However, our data suggest that when the tumor is well localized without full-thickness penetration, nodal metastasis, or extension to the line of resection (as in the 2 patients discussed), diverticulectomy alone can provide satisfactory control of cancer with minimal therapeutic risk.

Aged↗

PubMed1988

Incidence of Zenker's diverticulum with hiatus hernia.

The concomitant occurrence of Zenker's diverticulum and hiatus hernia in several patients prompted an investigation to determine whether there is a statistically significant increased incidence of hiatus hernia in patients with Zenker's diverticulum. Radiologic reports contained in 104 charts of patients from the University of Iowa with a diagnosis of Zenker's diverticulum were analyzed retrospectively for the presence of hiatus hernia. Radiologic reports contained in charts of a control group of patients, who had a barium swallow for work-up of a head and neck malignancy, were also analyzed. The control group had a 16% incidence of hiatus hernia, which was consistent with published data. The Zenker's diverticulum group had a 39% incidence of hiatus hernia, a statistically significant increase over the control group. The pathophysiology linking these conditions and the clinical implications of their relationship are discussed.

Adult↗

PubMed1990

[Pathogenesis and treatment of Zencker's diverticulum].

The aims of this study were: 1) To measure pharyngeal and upper oesophageal function manometrically at the same time as recording video images of the patient swallowing barium, in normal controls and patients with Zenker's diverticulum, and, 2) In those patients who progressed to surgery to biopsy the cricopharyngeus and compare the findings with biopsies from normal controls. Subjects were seated in front of a fluoroscope and video images of a barium swallow were synchronised with a multichannel recording catheter which contained 3 perfused side holes 1 cm apart (situated in the pharynx) and a 4 cm long perfused sleeve pressure sensor (positioned across the upper oesophageal sphincter). The coordination of the upper sphincter with swallowing, its relaxation, the pressures generated in the distal pharynx and the maximum luminal area of the open upper sphincter, were calculated for different volumes of barium swallowed in 11 patients with a Zenker's diverticulum (mean age 71 years, range 50-99) and 9 normal controls (mean age 65 years, range 55-86). Seven patients progressed to cricopharyngeal myotomy and their biopsies were compared with biopsies from 9 normal controls. In patients with Zenker's diverticulum intrapharyngeal pressures during barium swallows were significantly greater (p less than .05) and maximal luminal areas of the open sphincter were significantly less (p less than .05) than in control patients. In patients having a cricopharyngeal myotomy, intrapharyngeal pressures and maximum luminal areas returned to normal after surgery. The cricopharyngeus muscle of patients with a Zenker's diverticulum showed significantly increased fibrosis compared with normal controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed2002

Endoscopic stapling technique for the treatment of Zenker diverticulum vs standard open-neck technique: a direct comparison and charge analysis.

BACKGROUND: Presently, the 2 most widely used methods for the treatment of Zenker diverticulum are endoscopic stapling of the common party wall between the diverticulum sac and the esophagus and the standard open-neck technique involving diverticulectomy and cricopharyngeal myotomy. OBJECTIVE: To perform an analysis of the hospital charges to determine the economic efficiency of each technique based on our experience at the Mt Sinai Medical Center, New York, NY. METHODS: A retrospective analysis of 16 patients diagnosed as having Zenker diverticulum was conducted. Eight randomly chosen patients underwent endoscopic stapling with an EndoGIA 35-mm endoscopic stapler (Ethicon Inc, Somerville, NJ), and 8 randomly chosen patients underwent a standard open approach with diverticulectomy. Medical records were reviewed to determine operative time, length of hospital stay, time to oral intake, and postoperative complications. A charge analysis of the operative and postoperative fees was also performed. Statistical analysis between the 2 groups was conducted using analysis of variance and the paired t test. RESULTS: The mean +/- SD operative time for the endoscopic stapling technique was 25.5 +/- 15.78 minutes, which was significantly less (P<.001) than that for the open procedure, 87.6 +/- 35.10 minutes. The mean operative charges were roughly equivalent at US$ 5178 for the endoscopic procedure and US$ 5113 for the open procedure. The endoscopic procedure, while shorter in operative time, had the added expense of specialized equipment, specifically the EndoGIA endoscopic stapler. The mean +/- SD length of hospital stay for the endoscopic procedure was significantly shorter (P<.001) at 1.3 +/- 0.59 days vs 5.2 +/- 1.03 days for the open procedure. The inpatient hospital charges for the endoscopic group was also significantly less (P<.001) at a mean of US$ 3589 per stay vs US$ 11,439 for the open group. The mean +/- SD time to oral intake was significantly shorter (<.001) at a mean of US$ 3589 per stay vs US$ 11,439 for the open group. The mean +/- SD time to oral intake was significantly shorter (P<.001) in the endoscopic group at 0.8 +/- 0.26 days vs 5.1 +/- 1.25 days for the open group. There were no major complications in either group, and all patients experienced resolution of preoperative symptoms. CONCLUSIONS: Compared with the standard open technique, the endoscopic stapling technique for the treatment of Zenker diverticulum results in a statistically significant shorter operative time, hospital stay, and time to resume oral feedings. While the charges of the operative procedures were roughly equivalent, the total hospital charges were significantly less for the patients treated endoscopically.

Aged↗

PubMed2004

Bilateral vocal fold paresis after endoscopic stapling diverticulotomy for Zenker's diverticulum.

BACKGROUND: Zenker's diverticulum may be treated with a variety of surgical techniques. Endoscopic methods, specifically endoscopic stapling diverticulotomy, have gained increasing acceptance because of shorter operative times, decreased morbidity, with shorter hospital stays and time to resumption of oral feedings. METHODS AND RESULTS: We report the occurrence of bilateral vocal fold paresis after endoscopic stapling diverticulotomy for Zenker's diverticulum, previously unreported in the literature. This complication likely resulted from traction on the recurrent laryngeal nerves secondary to unfavorable patient anatomy. CONCLUSIONS: Endoscopic stapling diverticulotomy is a safe and effective treatment method for Zenker's diverticulum and remains our procedure of choice for most patients. However, inability to safely expose the diverticulum endoscopically results in a significant abandonment rate for attempted procedures and may result in significant postoperative complications.

Aged↗

PubMed2003

Diagnosis of caliceal diverticulum in two pediatric patients: a comparison of sonography, CT, and urography.

Caliceal diverticulum is a rare disorder in which a urine-filled cavity is connected to the renal calix by a narrow isthmus. Treatment of caliceal diverticulum varies depending on the complications, which include recurrent kidney infections, hematuria, and symptomatic calculi. The use of sonography may be insufficient for accurately diagnosing this condition; contrast urography, CT, or both also may be needed. We report the cases of 2 pediatric patients whose initial sonographic diagnosis was renal cystic disease but whose final diagnosis was caliceal diverticulum on contrast-enhanced urography in 1 case and both urography and CT in the other case. The patients received no further treatment but continue to receive follow-up care to monitor for the presence of infections and calculi. Accurate diagnosis of caliceal diverticulum in both cases spared the patients and their families the psychological burden of unnecessary further investigation of renal cystic disease. These cases emphasize the importance of using contrast-enhanced imaging modalities for confirmation when sonographic findings suggest the presence of renal cystic lesions.

Child, Preschool↗

PubMed1985

Primary lymphoma of Meckel diverticulum: a case report.

A case of a primary lymphoma of Meckel's diverticulum in a 6-year-old Iraqi boy presenting clinically as acute appendicitis is reported. Exploration revealed a ruptured gangrenous Meckel's diverticulum with an ileo-ileal intussusception at the diverticulum origin. A fairly comprehensive search through the English language literature has failed to reveal any other report of a primary lymphoma of Meckel's diverticulum leading to acute intestinal obstruction.

Appendicitis↗

PubMed1994

Analysis of intrabolus forces in patients with Zenker's diverticulum.

This report presents 10 patients with Zenker's diverticulum who were evaluated with simultaneous solid-state manometry and fluoroscopy. With this method, intrabolus forces are determined. Each patient had abnormal intrabolus forces regardless of the size of the diverticulum and cricopharyngeal muscle dysfunction. In the literature, there has been conflicting manometry results when studying Zenker's diverticulum. The use of analysis of intrabolus forces increases the sensitivity of manometric evaluation. This study establishes pressure abnormality in the pharyngoesophageal segment of patients with Zenker's diverticulum. The pathogenesis of Zenker's is presented based on these findings.

Deglutition↗

PubMed2007

Stress urinary incontinence as the presenting symptom of primary male urethral diverticulum-A case report and literature review.

Primary male urethral diverticulum is quite uncommon. It is even more unusual for urinary incontinence to be a presenting symptom of primary male urethral diverticulum. Herein, we report on a 32-year-old male presenting with urine leakage on coughing or abdominal strain beginning from his early twenties. A congenital type bulbar urethral diverticulum is diagnosed by voiding cystourethrography and cystourethroscopy. Endoscopic unroofing of the diverticulum freed the patient from stress urinary incontinence after the surgery.

Adult↗

PubMed1997

Biochemical markers of upper esophageal sphincter compliance in patients with Zenker's diverticulum.

The aim of this study was to investigate the biochemical basis of biomechanical and morphological alterations of upper esophageal sphincter, which have been reported in patients with Zenker's diverticulum. 4-L-Hydroxyproline (4-Hyp) (collagen), isodesmosine (Ides), and desmosine (Des) (elastin) contents were measured in samples of cricopharyngeal muscle (CPM) and muscularis propria of the esophagus below the CPM. The specimens were collected from seven patients operated for Zenker's diverticulum and eight cadavers, without esophageal and connective tissue disease, 4-Hyp was assayed colorimetrically, Ides and Des by high-performance liquid chromatography. Mean (+/-SEM) values were compared by Mann-Whitney U test. In patients, collagen content was significantly increased, both in CPM and in the muscularis propria of the esophagus below the CPM (P < 0.05). In CPM, Ides to Des and collagen to elastin ratios were significantly higher in patients than in controls (P < 0.05). Both the CPM and the upper muscular cuff of the esophagus appear to be involved in the pathogenesis of Zenker's diverticulum. This finding supports the extension of the myotomy to the muscularis propria of the esophagus below the CPM. The alterated Ides to Des ratio suggests a primary disease of CPM as a cause of Zenker's diverticulum.

Aged↗

PubMed1993

Angiographic findings of Meckel's diverticulum: the characteristic appearance of the vitelline artery.

Angiographic findings of the vitelline artery in five patients with surgically proven Meckel's diverticulum were reviewed retrospectively. Superselective vitelline arteriography was performed in two patients and superior mesenteric arteriography in three. Arteriography showed the elongated artery without branching originating from the distal ileal artery and a group of tortuous vessels at the distal portion of this artery in all patients. A dense capillary staining of the vitelline artery was exclusively shown in patients with ectopic gastric mucosa. In one patient, injection of methylene blue intraoperatively through a previously placed angiographic catheter into the vitelline artery stained only the vitelline artery and Meckel's diverticulum in blue but neither the mesentery nor the ileum. Demonstration of a nonbranching artery from the ileal artery and a group of dilated tortuous vessels at the distal portion of this artery should suggest the possibility of Meckel's diverticulum and can be confirmed by selective injection of the artery. It should be emphasized that angiography can detect Meckel's diverticulum even in the absence of acute bleeding.

Adolescent↗