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PubMed1991

Inverted colonic diverticulum: air contrast barium enema findings in six cases.

A polypoid elevation of the colonic wall was identified on air contrast barium enema in six patients. The abnormality in each case was found to be an inverted colonic diverticulum. Inverted diverticula appeared as broad-based, smooth, sessile polyps measuring 1.5-2.0 cm. In five of the six patients a characteristic central umbilication and/or evidence of barium within the polyp could be identified. The diagnosis was confirmed in three patients by demonstrating an everted diverticulum replacing the suspected lesion. In the remaining three patients, two of whom had normal findings on colonoscopy, the diagnosis was strongly suggested by the presence of barium extending into the substance of the mass. Additional radiologic maneuvers or a second study may permit accurate diagnosis if the possibility of inverted diverticulum is considered. However, even when the diverticulum cannot be demonstrated, a central umbilication or barium within a smooth intraluminal projection should suggest inverted diverticulum and prevent unnecessary endoscopy or inadvertent diverticulectomy.

Adult↗

PubMed2003

Involvement of Meckel diverticulum in Crohn disease associated with pancreatic heterotopia.

Although the association of Crohn disease and Meckel diverticulum has been widely reported, the direct involvement of a Meckel diverticulum by Crohn disease is less common and is usually the result of contiguous spread. The presence of heterotopic tissues in an affected diverticulum is rare and most often consists of gastric mucosa. We report herein the presence of Crohn disease within a Meckel diverticulum, with a normal small bowel immediately adjacent to the diverticulum, associated with pancreatic heterotopia.

Adult↗

PubMed1996

[Mesonephric adenocarcinoma arising in the female urethral diverticulum].

A forty four-year-old house-wife presented with gross hematuria and difficulty on urination of a year and 3 months duration. Transvaginal examination showed a hen egg-sized soft mass on the anterior vaginal wall. Urine cytology revealed many clusters of malignant cells suggestive of adenocarcinoma. Cystourethrography revealed two urethral diverticula, whose orifices were cystoscopically located at the proximal and distal side of urethral sphincter, respectively. By vaginal digital pressing, a soy-bean sized papillary tumor came out of the proximal diverticulum. Histopathological examination of the biopsied tumor suggested poorly differentiated transitional cell carcinoma with inverted growth. Under the diagnosis of carcinoma arising in the urethral diverticulum, anterior pelvic exenteration with formation of Indiana pouch was carried out. The tumor in the proximal diverticulum was histologically composed of a variety of adenocarcinomatous pattern, such as tubular, papillary and cystic structure with a distinctive pattern of tubules lined by a superficial layer of hobnail cells, leading to the diagnosis of mesonephric adenocarcinoma of urethral diverticulum. Postoperative radiation therapy was given because the diverticulum was adherent to the pubic bone, though lymph node metastasis was negative. She has been well with no evidence of the disease for 1 year and 4 months after the operation. Although the histogenesis of female urethral mesonephric adenocarcinoma was still controversial, this case seems to be the forty fourth case in the world literature.

Adult↗

PubMed2006

[Operative position suitable for transvaginal excision of urethral diverticulum or closure of urethrovaginal fistula].

Among the various surgeries in female urology, transvaginal excision of urethral diverticulum needs careful and meticulous procedures in order to avoid some operative complications, such as urethral stricture or urethrovaginal fistula. In the present report, we present a woman with urethral diverticulum who initially underwent transvaginal excision of diverticulum in the dorsal lithotomy position, but she was complicated with urethrovaginal fistula postoperatively. Unfortunately, we failed to repair her fistula when she underwent excision of the fistula in the dorsal lithotomy position. With reconsideration of an operative position useful for transvaginal surgery, we succeeded in fistula closure in the Jackknife prone reverse-lithotomy position, and thereafter, two subsequent patients with urethral diverticulum were successfully treated with transvaginal excision of diverticulum in this operative position. In the transvaginal approach to the peri-urethral disorders, the Jackknife prone reverse-lithotomy position was notably superior to the dorsal lithotomy position with the following advantages: (1) the surgeons can easily operate in a bright and large surgical site without any blind view. (2) the surgeons can dissect and suture safely and accurately. (3) the assistants also can help in the operation bimanually in the same view as the surgeon when the posterior vaginal wall is fixed with a retractor.

Adult↗

PubMed2002

Esophageal diverticulum associated with Aerococcus viridans infection in a loggerhead sea turtle (Caretta caretta).

A juvenile loggerhead sea turtle (Caretta caretta) stranded in Gran Canaria, Spain was necropsied. The turtle was underweight, had sunken eyes, and small amounts of crude oil were in the oral cavity. The most significant lesion was a large esophageal diverticulum at the junction of the esophagus and stomach. The diverticulum was full of gas and green mucoid fluid and a diffuse thick yellow fibrinonecrotic membrane covered the mucosa. The lumen of the diverticulum also contained moderate numbers of cephalopods, crustaceans, and anthropogenic debris including crude oil balls, plastics, and fishing lines. Histologically there was a severe diffuse fibrinonecrotic esophagitis. Aerococcus viridans was isolated from the diverticulum. This is the first report of an esophageal diverticulum in a sea turtle. Although A. viridans is a known pathogen of lobsters and fishes, there are no reports of A. viridans infection in sea turtles.

Animals↗

PubMed1997

Typical sonographic appearance of duodenal diverticulum.

During routine transabdominal ultrasonography of the hepatobiliary tract an occasional persistent bright linear or concave echo was detected that disrupted the normal images we routinely obtained of the pancreatic head. We began to suspect this echo to be the sonographic representation of a duodenal diverticulum. To confirm our suspicions we performed a prospective study. Over a 20 month period, 30 consecutive patients with a sonographically suspected duodenal diverticulum were followed up with either an upper gastrointestinal series, gastroscopy, or, depending on the patient's clinical symptoms, endoscopic retrograde cholangiopancreaticography. One patient was examined with simultaneous fluoroscopy and ultrasonography. The results of these examinations were then compared to the respective ultrasonograms by a qualified radiologist and sonographer. The suspected duodenal diverticulum, detected primarily with ultrasonography, was confirmed with follow-up examinations in all 30 patients. The persistent echo detected sonographically had the same anatomic position as the diverticulum seen during fluoroscopy. We concluded that duodenal diverticulum located near the pancreatic head has a rather typical sonographic appearance.

Diverticulum↗

PubMed1999

[Scrotal pseudoabscess revealing congenital diverticulum of the anterior urethra in children].

The authors report a case of infected congenital diverticulum of the anterior urethra in a 6-week-old infant. This diverticulum presented clinically in the form of a scrotal abscess. Retrograde cystourethrography established the diagnosis. Two-stage treatment was preferred because of the infection: aspiration of the diverticulum and antibiotics, subsequently followed by surgical repair with resection of the diverticulum and immediate urethral reconstruction. The immediate postoperative course was marked by demonstration of hypertrophic pylori stenosis, which had not been previously investigated despite the presence of symptoms predating the diverticulum (repeated vomiting at the age of one month). Treatment was surgical. A brief review of diverticula of the anterior urethra is presented, defining the aetiological factors as well as the diagnostic and therapeutic features.

Abscess↗

PubMed1999

Giant colonic diverticulum: report of a case.

Giant colonic diverticulum is a rare complication of colonic diverticulosis. It typically occurs as a single diverticulum located on the antimesenteric border of the sigmoid colon. The most widely accepted theory for its development attributes the progressive dilation to a "ball-valve" mechanism, allowing air to enter but not to exit. Patients usually present complaining of abdominal pain and/or an abdominal mass, although they may remain asymptomatic. Physical examination reveals a tympanic abdominal mass that appears as a round radiolucency on plain radiographs and CT. Barium enema demonstrates the relationship of the diverticulum to bowel and may document communication with the colonic lumen. To alleviate symptoms and prevent complications, the recommended treatment is excision of the diverticulum in continuity with the involved colonic segment. We report a case and discuss the presentation, diagnosis, and management of giant colonic diverticulum.

Aged↗

PubMedDate not supplied

[Giant bladder diverticulum, inside inguinal hernia. Clinical case and review of the literature].

OBJECTIVE: To report a case of giant diverticulum of the bladder associated with inguinal hernia. METHODS/RESULTS: An uncommon case of giant diverticulum associated with inguinal hernia is presented and the literature reviewed. The enormous size of the diverticulum and the associated lower urinary tract obstruction arising from hyperplasia of the prostate required resolution of both conditions. This was achieved by diverticulectomy with herniorrhaphy and TURP. CONCLUSIONS: Diverticula of the bladder are associated with lower urinary tract obstruction that are generally caused by a prostatic condition. Hernia with bladder diverticulum is uncommon. The symptoms are usually scanty and cannot be distinguished from the voiding symptoms arising from prostatic involvement. Apart form the clinical findings, US, cystography or IVP are useful for diagnosis. Treatment is usually by surgical correction of both the bladder diverticulum and voiding obstruction from prostatic hyperplasia.

Aged↗

PubMed2000

Obstructing giant colonic diverticulum.

We report the second case of an obstructing true colonic diverticulum. Of the 103 cases of giant sigmoid diverticulum found in the literature, 13% have been reported as true giant sigmoid diverticulum, ie, containing all layers of the colonic wall. Our 75-year-old patient had clinical symptoms for only 6 months, and endoscopy revealed an almost totally obstructing mass 20 cm from the anus. Surgical resection of the sigmoid colon with a primary anastomosis resolved all of the patient's obstructive symptoms. A flap-valve mechanism was the cause of this true giant colonic diverticulum. Microscopic examination of the diverticulum wall revealed all normal layers of colon wall.

Aged↗

PubMedDate not supplied

[Zenker's diverticulum. Apropos a case].

The authors report a case of Zenker's diverticulum in a patient 72 years old who underwent surgery. The pharyngoesophageal function was investigated before and after cricopharyngeal myotomy and diverticulopexy, with oesophageal manometry. Preoperative manometry showed an incomplete relaxation of the upper oesophageal sphincter and increased of pharyngeal pressure. This diverticulum has a pulsion pathogenesis and in this case is not associated with gastroesophageal reflux. It is important to check whether an associated oesophageal pathology exist once Zenker's diverticulum has been diagnosed: X-ray examination of oesophagus and stomach are capable of identifying the presence of diverticulum as well as other pathological association. In the case showed the clinical manifestation are represented by: cervical dysphagia, sensation of foreign body while eating due to the accumulation of ingested food in the diverticulum, and noisy deglutition. The surgical treatment in this case consist of diverticulopexy with cricopharyngeal myotomy. This case is treated with diverticulopexy for two reason: because is not very big and to reduce post-operative period. In conclusion the authors shows the importance of this surgery for not very large sized pouches, and emphasise the importance of manometric and radiographic control in pre and post-operative period. This kind of surgery reduce post-operative complication and the period to stay in bed.

Aged↗

PubMed2000

The value of angiography in diagnosis of Meckel's diverticulum: case report.

Meckel's diverticulum is the most common anomaly of the gastrointestinal tract and usually produces no symptoms, although the classic symptom is painless rectal bleeding in a child. Because most symptomatic diverticula in children contain ectopic gastric tissue, radionuclide imaging using a technetium 99m pertechnetate scan is considered to be the method of choice. However, a bleeding Meckel's diverticulum may not be detected by pertechnetate imaging despite the presence of ectopic gastric mucosa. When the scan is negative, visceral angiography is an alternative procedure for detecting Meckel's diverticulum. We encountered a case of pathology-proven Meckel's diverticulum whose angiography result was diagnostic, while upper gastrointestinal panendoscopy, colonofibroscopy, barium enema studies, and repeated radionuclide scans were all negative. We report on this case to emphasize the potential role for angiographic detection of Meckel's diverticulum.

Angiography↗

PubMed2000

[Two cases of nephrogenic adenoma in the bladder diverticulum].

We report two cases of a nephrogenic adenoma in the bladder diverticulum. The first patient was an 81-year-old man with gross hematuria. Cystoscopy revealed bladder diverticulum and a papillary tumor within. Bladder diverticulectomy was performed and the histopathological diagnosis was a nephrogenic adenoma. The second patient was a 50-year-old man with gross hematuria and dysuria. Transabdominal ultrasound revealed bladder diverticulum. Transurethral coagulation of the bladder diverticulum was performed. Then three papillary tumors were detected, and were resected transurethrally. The histopathological diagnosis was a nephrogenic adenoma. These are the first and second cases of a nephrogenic adenoma in the bladder diverticulum reported in Japan.

Adenoma↗

PubMed2001

Meckel's diverticulum causing cecal volvulus.

Meckel's diverticulum is present in 2 per cent of the population with bowel obstruction as its most common complication. This case report describes an extremely rare complication of a Meckel's diverticulum, a cecal volvulus. The diagnosis of cecal volvulus was made preoperatively on abdominal X-rays; the diagnosis of a Meckel's diverticulum was made intraoperatively. The cecum was found to be twisted around a vitelline band on a broad-based Meckel's diverticulum extending to the umbilicus. The diverticulum was resected. The patient did well postoperatively and was discharged without any difficulty.

Adult↗

PubMedDate not supplied

Isolated congenital left ventricular diverticulum in adults.

Isolated congenital ventricular diverticulum or aneurysm is rare and usually arises from the left ventricle. The presentation of this condition is diverse. We report three cases of isolated congenital left ventricular diverticula. The age range was 17-30 years. Chest X-ray provided the earliest clinical suspicion in these three cases of a cardiac anomaly which was diagnosed by echocardiography and confirmed by angiocardiography. The location of the congenital left ventricular diverticulum was the left ventricular apex in two cases and basal in the other. We conclude that congenital left ventricular diverticulum is a disease of protean presentations. A high index of suspicion is necessary while interpreting chest X-rays and echocardiographs to diagnose congenital left ventricular diverticulum. A contractile accessory chamber of the left ventricle with a narrow neck with or without midline defects and an electrocardiogram without Q waves is consistent with the diagnosis of congenital left ventricular diverticulum.

Adolescent↗

PubMed2003

[Clinical evaluation of gastric diverticulum on indirect radiograph for gastric mass survey].

The aim of this study was to evaluate the clinical conditions of gastric diverticulum. Fifty-four patients with gastric diverticulum (20 men and 34 women among 34,314 patients who underwent medical check-ups) were evaluated on indirect radiographs, for an incidence of 0.16% among the total number of examined cases, a rate lower than that of previous reports. Almost all cases were asymptomatic, had a single diverticulum, and showed a saccular shape. The age distribution indicated higher frequencies in the 5th and 6th decades, and the posterior wall of the fornix was the most common location. Size ranged from 0.6 cm to 12 cm, and 41 cases (75.9%) were between 1.0 cm and 4.0 cm in size. This entity should be kept in mind when reading radiographs of upper gastrointestinal series as well as recognition of pseudodiverticulum and aberrant pancreas as noted for the stomach in several past report. Diverticulum on the cardia, which was previously classified as gastric diverticulum, should be excluded because of the possibility of normal variation.

Adult↗

PubMed1992

Vesico-diverticular fistula: a rare complication of Meckel's diverticulum.

Enterovesical fistulas usually result from diverticulitis, Crohn's disease, or colorectal cancer. A perforated Meckel's diverticulum can also result in an vesico-diverticulum fistula, as noted in three previously reported cases. In all three cases, bladder or bowel disease was associated with the fistula. Herein, the authors describe a previously healthy, 23-year-old man who presented with an enterovesical fistula. Exploratory laparotomy revealed a vesico-diverticular fistula resulting from a perforated Meckel's diverticulum. Pathologic examination revealed that the diverticulum did not contain ectopic gastric or pancreatic tissue and that the perforation was secondary to an enterolith. The patient underwent a diverticulectomy and had an uneventful postoperative course. Unlike any of the three previously reported cases, the authors' patient had no coexisting bowel or bladder disease occurring with his vesico-diverticular fistula. To the authors' knowledge, this is only the third reported case of a vesico-diverticular fistula resulting from a perforated Meckel's diverticulum that did not contain ectopic tissue. It represents the first case where the perforation was secondary to an enterolith.

Adult↗

PubMed2003

[Complicated Meckel's diverticulum].

BACKGROUND: In this study we present our experience in the surgical treatment of complicated Meckel's diverticulum. METHODS: The data of eight patients who underwent surgery due to complications of Meckel's diverticulum between 1994-2001 was retrospectively assessed. RESULTS: There were six males and two females with a mean age of 31 years (range 13 to 65). Preoperative diagnoses were acute surgical abdomen in six and incarcerated inguinal hernias in two patients. Intraoperative diagnoses were as follows; Littre's hernia in two, diverticulitis in two, perforation of the diverticulum in one and intestinal obstruction in three patients (there was a band extending from diverticulum to the umbilicus in two patients and a mesodiverticular band in the remaining one). While diverticulectomies were performed in five patients, three had small bowel resections. The mean diameter of the diverticula was 2.3 cm (range 2 to 4) and the mean length was 3.5 cm (range 3 to 8). Postoperative intestinal obstruction was observed in one patient who had underwent diverticulectomy and subsequently a small bowel resection was performed. CONCLUSION: Being aware of the complications of the Meckel's diverticulum is necessary in correct timing of the surgery and selecting the proper incision in patients with acute abdomen. This will result in decreased morbidity.

Abdomen, Acute↗