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PubMedDate not supplied

ERCP in patients with periampullary diverticulum.

BACKGROUND/AIMS: Duodenal diverticula, discovered incidentally in patients during endoscopic retrograde cholangiopancreatography, are usually asymptomatic, but can be the source of significant morbidity. The aim of this study was to evaluate the indications for endoscopic retrograde cholangiopancreatography, the course of this procedure and complications after this procedure in patients with periampullary diverticulum. METHODOLOGY: Clinical, laboratory, ultrasonographic, and endoscopic retrograde cholangiopancreatography data of 626 patients from a single endoscopy center were retrospectively analyzed. RESULTS: The periampullary diverticulum was identified in 72 patients (11.5%). The difficulty in cannulation of papilla of Vater was encountered in 57 patients (79.2%) with diverticulum compared to 54 patients (9.7%) without diverticulum (P < 0.001). Cannulation of common bile duct was successful in 592 patients (94.6%). Cannulation of common bile duct failed in 8 patients (11.1%) with diverticulum compared to 26 patients (4.7%) without diverticulum (P = 0.046). Patients without diverticulum (n = 168, 31.9%) had two-times more often dilated common bile duct > or = 6 mm without stone on ultrasound compared to patients with diverticulum (n = 12, 17.6%) (P = 0.017). Patients with diverticulum presented 1.8-times more often with retained stone in the common bile duct than patients without diverticulum (16.7% vs. 9.7%). 17.3% of patients developed post-endoscopic retrograde cholangiopancreatography complications, which did not significantly differ in both groups. However, the patients who presented with retained common bile duct stones had higher post-endoscopic retrograde cholangiopancreatography complications (P = 0.011). CONCLUSIONS: Cannulation of the common bile duct is more difficult in patients with periampullary diverticulum and requires more skills. Periampullary diverticulum is also associated with higher risk of retained stones in the common bile duct which may lead to higher post-endoscopic retrograde cholangiopancreatography complication rate.

Adult↗
PubMed2006

Bursa tract diverticulum in the hermaphroditic land snail Arianta arbustorum (Stylommatophora: Helicidae): morphology, function, and evolutionary implications.

A bursa tract diverticulum is widespread in the female part of the hermaphroditic reproductive system of stylommatophoran pulmonates. However, the ultrastructure of the diverticulum is unknown and there is only anecdotal evidence for a spermatophore-dissolving function for this organ. In the present study, we examined the ultrastructure of the diverticulum and investigated histological, histochemical, and morphometric changes at different time intervals after mating in the simultaneously hermaphroditic land snail Arianta arbustorum. The diverticulum in this species of snail is a prominent organ, consisting of a luminal columnar epithelium surrounded by a thick layer of connective tissue. During mating, the diverticulum functions as the site of spermatophore uptake. Within the lumen of the diverticulum the spermatophore wall is dissolved or at least partly broken down. The digested material is taken up by epithelial cells and accumulated in molluscan-specific cells of the connective tissue, the so-called rhogocytes. Subsequent to copulation, the total diameter of the diverticulum increases markedly, reaching a maximum size 12 h after mating, while at the same time the thicknesses of the diverticulum wall and diverticulum epithelium decrease. The length of the diverticulum shows a positive allometry and a high phenotypic variation compared to snail size, which suggests that the diverticulum is under directional sexual selection. We propose that the diverticulum in A. arbustorum has evolved in response to selection pressures imposed by divergent evolutionary interests between male and female function.

Animals↗
PubMedDate not supplied

[Functional changes in the bladder of children with primary bladder diverticulum].

OBJECTIVE: Primary vesical diverticulum is generally diagnosed during urological evaluation for recurrent urinary tract infection that are frequently associated with the symptoms of urinary dysfunction. A urodynamic study was performed in children with primary vesical diverticulum to confirm or discard the presence of vesicourethal dysfunction, its relationship with vesicoureteral reflux, which is associated with diverticulum, and the results achieved by surgical versus medical treatment. METHODS/RESULTS: A urodynamic study was carried out in 11 children (7 boys and 4 girls), aged 6 to 13 years, with primary vesical diverticulum. The diverticulum was parameatal in 7 cases (4 with reflux), posterolateral in 2 cases (1 with reflux), anterolateral in 1 patient and 1 patient had multiple bladder diverticula without neurological disorder. Surgery was indicated in 8 cases and 3 were managed conservatively. Vesicourethral function, at the time the diverticulum was diagnosed, was normal in 3 (27%) and pathological in 8 (73%) patients. The urodynamic study disclosed uncoordinated vesicosphincteric function (4 pts), vesical instability (3 pts) and vesical hypotony (1 pt). Of these 4 cases with urodynamic disorders, diverticulum was associated with vesicoureteral reflux. Of the 8 children submitted to surgery, 6 had a functional pathology preoperatively; following surgical treatment of the diverticulum, vesicourethral function returned to normal in all cases. Of the 3 cases managed conservatively, 2 had persistent urodynamic disorders despite drug therapy; one of them had clinical features of urinary incontinence. CONCLUSIONS: These fundings suggest that alterations of bladder function might arise from the anatomic changes in the detrusor muscle causing the diverticulum and contribute to the onset or persistence of reflux, and should be considered an additional criterion for indicating surgery. It is therefore suggested that a urodynamic study for its diagnosis be included in the protocol for evaluation of children with primary vesical diverticulum.

Adolescent↗
PubMed1995

Incidence, complications, and management of Meckel's diverticulum.

OBJECTIVES: To elucidate the incidence of Meckel's diverticulum; to determine the correlation between the histologic type of the diverticulum's mucosa and its clinical presentation; and to review our experience with Meckel's diverticulum. DESIGN: Case-control study. SETTING: University hospital in Ioannina, Greece. PATIENTS: A total of 2074 patients undergoing an appendectomy were examined intraoperatively for Meckel's diverticulum (subgroup A1). In addition, Meckel's diverticulum was found incidentally in 15 patients who were undergoing intra-abdominal surgery (subgroup A2). An operation for a complicated Meckel diverticulum was performed in an additional 15 patients (group B). RESULTS: Thirty-three (1.59%) Meckel diverticulae were found incidentally among 2074 patients in subgroup A1. A positive correlation between Meckel's diverticulum and male sex was found (P < .004), but no difference was found in sex distribution between patients in group B and subgroup A1 (P < .6744). The histologic type of the mucosa (gastric) had significant positive correlation with the clinical presentation of the diverticulum (complicated) (P < .001). CONCLUSION: Resection of the unexpected Meckel diverticulum can be performed safely with a low complication rate, regardless of the patient's age.

Abdomen↗
PubMed2003

Transvaginal ultrasound for the diagnosis of urethral diverticulum.

PURPOSE: We reviewed our experience with urethral diverticula and transvaginal ultrasound to evaluate female patients with this condition. MATERIALS AND METHODS: All female patients who underwent transvaginal ultrasound during evaluation for urethral diverticulum at our institution between May 1995 and April 2002 were identified by searching a data base. We reviewed the diagnostic evaluation and compared diagnostic techniques with transvaginal ultrasound for diagnosing urethral diverticulum. RESULTS: Of the 25 patients with suspected urethral diverticulum who underwent transvaginal ultrasound as a diagnostic procedure 10 (40%) were diagnosed with urethral diverticulum, including 10 in whom it was confirmed by surgery or other diagnostic procedures. Transvaginal ultrasound was less expensive than the other diagnostic modalities and in no case did it miss a urethral diverticulum that was identified by another diagnostic technique. Urethral diverticulum was detected on 1 of 3 voiding cystourethrograms (33%) and this study missed the diagnosis in 1 case that was diagnosed by transvaginal ultrasound. Three cases of urethral diverticulum were noted on transvaginal ultrasound after they were missed by cystoscopy. Videourodynamics were unable to diagnose urethral diverticulum. CONCLUSIONS: Transvaginal ultrasound is effective for evaluating patients with suspected urethral diverticulum. It is less expensive and may identify diverticula missed by other diagnostic modalities.

Adult↗
PubMed1999

[Ultrasonographic diagnosis of Meckel's diverticulum--case report].

Meckel's diverticulum is the congenital anomaly of the gastrointestinal tract affecting about 2% of the population. It is a true diverticulum containing all layers of the ileum wall. Heterotopic tissue is frequently present (25%): gastric mucosa, duodenal mucosa, jejunal mucosa and pancreatic tissue. Meckel's diverticulum is localized about 50 cm from the ileo-colic valve on the external border of the ileum. Most of Meckel's diverticula are clinically silent; clinical symptoms (19%) are in cases of complications such as: strangulation of the bowel in a ring formed by the diverticulum, intussusception of the diverticulum into the ileum, volvulus, incarceration of the diverticulum in hernia, tumour originating in the diverticulum. The diagnosis of Meckel's diverticulum is very difficult. The most useful in the diagnosis are plain abdominal radiographs, barium studies, CT, sonography and scintigraphy Abdominal sonography shows a tubular fluid structure localized far from the coecum. The wall of the diverticulum is swollen and in the lumen are chyme or fat.

Child, Preschool↗
PubMed1992

[Zenker's diverticulum in the elderly. Description of a case and surgical treatment].

The authors report a case of Zenker's giant hypopharyngeal diverticulum in an elderly patient who underwent surgery due to the severity of symptoms. This diverticulum, which is both juxtasphincteric and epiphrenal, has a pulsion pathogenesis: the presence of a hernia on the esophageal side (jato?), with which Zenker's diverticulum is frequently associated and which is often followed by reflux esophagitis, is enough to cause motor asynchronism of the crico-pharyngeal muscle which, in the presence of hypertonic conditions during deglutition, leads to the formation of a high-pressure pouch which is then responsible for the formation of the diverticulum itself. It is therefore important to check whether an associated esophageal pathology exists once Zenker's diverticulum has been diagnosed: X-ray examinations of the upper digestive tract are undoubtedly capable of identifying the presence of the diverticulum as well as other pathological associations. In the present case it was not possible to perform a sufficiently exhaustive X-ray examination in order to exclude associated esophageal pathologies. Endoscopy may be superfluous and contraindicated in cases of large diverticular pouches. Symptoms vary depending on the size of the diverticulum. A feeling of dysphagia may precede the appearance of the diverticulum, even by several years, before the onset of symptoms related to the ingestion of food: initially the patient may experience the sensation of a foreign body while eating due to the accumulation of ingested food in the diverticulum; this is followed by halitosis, sialorrhea, noisy deglutition, regurgitation of undigested food especially during sleep, and frequently bronchopulmonary symptoms "ab ingestis".(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

[Meckel's diverticulum. Symptoms, diagnosis and treatment].

Meckel's diverticulum is a rare, but serious cause of acute abdominal pain. The prevalence of Meckel's diverticulum is 2% and lifetime risk of illness in a diverticulum is 4.2%. The risk declines with age and approaches zero after the age of 70. Morbidity after resection of symptomatic Meckel's diverticulum is 11.1-17.6% with 6.0-7.5% mortality. The morbidity rate for resection of incidentally discovered diverticulum is 1.2-8.9%. Symptoms and complications are related to age. Below the age of one year the most prevalent complication is gastrointestinal obstruction. Later in childhood the most dominating complication is peptic ulcer with serious gastrointestinal bleeding, while various kinds of gastrointestinal obstruction and diverticulitis are most prevalent in adults. The treatment of symptomatic Meckel's diverticulum is resection. However, the treatment of incidentally discovered Meckel's diverticulum is a subject of dispute. After a thorough study of the literature we conclude that resection should be the routine for all incidentally discovered Meckel's diverticulums in persons younger than 40. After this age resection should be reserved for patients with palpable stigmata of heterotopic tissue, diverticulums of some length and the presence of omphaloenteric- or omphalodiverticulare chords.

Adult↗