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At least 19 recordsLinked to original sources
PubMed1976

The natural history of Meckel's Diverticulum and its relation to incidental removal. A study of 202 cases of diseased Meckel's Diverticulum found in King County, Washington, over a fifteen year period.

To determine the natural history of Meckel's diverticulum, 202 case records of proved disease of Meckel's diverticulum were retrieved, covering a fifteen year period, from all the hospitals of King County, Washington (population, 1,143,800). Using the figure of 2 per cent incidence of Meckel's diverticulum, we calculated that a Meckel's diverticulum has a 4.2 per cent likelihood of causing disease during a lifetime, decreasing to zero with old age. Using previously published mortality and morbidity figures, we calculated that to save one patient's life from the complications of Meckel's diverticulum, it would be necessary to remove approximately 800 asymptomatic Meckel's diverticula. This would be likely to incur a significant amount of postoperative morbidity from postoperative intestinal obstruction and infection. We suggest that the prophylactic removal of Meckel's diverticulum is rarely, if ever, justified.

Adolescent↗
PubMed1977

[The intramural duodenal diverticulum, a topical variation of the intraluminal duodenal diverticulum (author's transl)].

The intramural duodenal diverticulum is a topical variation of the intraluminal duodenal diverticulum. It is manifested not before adult age by noncharacteristic upper abdominal symptoms. Diagnosis is made by radiologic examinations, the therapy is excision of the diverticulum. Structure and topography of the diverticulum are explained by its embryological development.

Adult↗
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↗
PubMedDate not supplied

Cricopharyngeus myotomy as the only treatment for Zenker diverticulum.

Cricopharyngeal dysfunction, one of the most common causes of pharyngeal dysphagia, exhibits a variety of manifestations, one of which is Zenker diverticulum. This paper examines the physiology of swallowing, pathophysiology of its aberrations, and various methods of treating Zenker diverticulum. It is our purpose to emphasize cricopharyngeus (CP) myotomy as the only needed treatment for this diverticulum. Even in its advanced stages, excision of the diverticulum is a needless surgical exercise. Seven cases of Zenker diverticulum are reported in elderly patients; one of them had an excision of the diverticulum prior to presentation. Some were either completely obstructed or aspirating on esophagram. Cricopharyngeus myotomy, the only treatment provided, proved to be safe and effective without morbidity or fatalities. Patients' ability to eat orally was restored on the night of or the morning after surgery. No Levin tube is necessary and there is no risk of suture line leakage after the conventional diverticulectomy and CP myotomy. Hospital stay is greatly reduced and there is no risk of structure formation. In contrast to endoscopic division of CP muscle, there is no risk of mediastinitis because there is no break through the mucosa.

Aged↗
PubMed1976

Meckel's diverticulum.

One hundred and ninety surgically documented cases of Meckel's diverticulum encountered at the Mayo Clinic during a 51-year period, 1920 through 1971, are reviewed. In 39 patients, the diverticulum was left undisturbed. In 51 patients, the diverticulum was the primary surgical disease, and, in 100 patients, the diverticulum was removed incidentally. The clinical features are presented as well as the surgical considerations. Meckel's diverticulum is a relatively frequent development anomaly with eccentric manifestations, and its surgical management has intrigued physicians for over 350 years. Dr. Charles W. Mayo stated, "Meckel's diverticulum is frequently suspected, often looked for, and seldom found."

Adolescent↗
PubMed1975

Radial distribution of esophageal peristaltic pressure in normal subjects and patients with esophageal diverticulum.

This study was designed to determine the radial profile of peristaltic pressure waves in the esophageal body of normal subjects and patients with isophageal diverticulum. We used a manometric assembly featuring four radial side hole recording orifices oriented at equidistant 90 degree angles. Each recording catheter was infused with water at a rate (6.1 ml per min) which provided high fidelity pressure recording. In normal subjects, the radially recorded peristaltic pressure complexes were similar in peak amplitude and wave form. The range of pressure differences between the four radial recordings averaged 9.0 +/- 4 SD mm Hg A range is less than or greater to 25 mm Hg occurring in 99% of observations. These variations in pressure amplitude showed no consistant spacial orientation. In 5 of the 6 patients with esophageal diverticulum, the range of radial peristaltic pressure differences exceeded 25 mm Hg in the region of the diverticulum, the lowest pressure occurring at the recording orifice facing the diverticulum mouth. In occasional peristaltic sequences abnormal wave forms featuring abrupt onsets or offsets were observed. These bizarre wave forms were probably caused by oralaboral diverticulum movement relative to the recording sensor during peristalsis. Two patients had abnormally high peristaltic pressure amplitudes, greater than 250 mm Hg. This latter finding introduces the possibility that hypertensive peristaltic contractions may contribute to diverticulum production in some patients.

Adult↗
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↗
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↗
PubMed1977

Syndrome of congenital ventricular diverticulum and midline thoraco-abdominal defects.

The long-term follow-up of a 30-year-old patient who had a correction of the syndrome of left ventricular diverticulum and thoraco-abdominal defects is presented. The main features of the syndrome include a diverticulum of the left ventricle, a ventricular septal defect, and sometimes other cardiac anomalies. The thoraco-abdominal defects consist of foreshortened sternum, pericardial and diaphragmatic defects, and umbilical hernia. The association of these anomalies is thought to be due to a developmental failure of the primitive paramidline mesoderm. The diagnosis can be made clinically by the presence of a pulsatile, epigastric mass associated with signs of cardiac septal defects and dextrocardia. The prognosis of patients with this syndrome depends mainly on the associated abnormalities although rupture of the diverticulum can be a fatal complication. The treatment of choice is resection of the diverticulum combined with repair of associated anomalies which can give good early and late results.

Abdomen↗
PubMed1976

[Clinical importance of Meckel's diverticulum].

Between 1966 und 1975 42 children and 46 adults were operated on Meckel's diverticulum. The diverticulum is explained as one of the possible disturbances during regression of ductus omphaloentericus. The appendicitis-like symptomatology correlates to the involvement of gastric and colonic mucosa as well as heterotopic exo- and endocrine tissue of the pancreas in the wall of the diverticulum. In 34% complications were due to inflammation, perforation, bleeding, intussusception, volvulus, gut-strangulation with ileus, ulcer, neoplasia or lesion by foreign bodies. 4 out of 88 patients died. Preoperative diagnostic fails in 75%, therefore in every case the distal gut should be inspected and every diverticulum should be resected.

Adult↗
PubMed1979

[Tractional diverticulum of the urinary bladder as a component in recurring inguinal hernias].

The tractonal diverticulum as contained in recidivating inguional hernia occur rather often. They are created most often during plastic surgical treatment most frequently in inguinal hernia repairs in which a suture partially or completely passes through the urinary bladder and fixes it to the layers of inguinal canal when it is being sutured. They also occur when the bladder is accidentally pinched while the sutures are being pulled taught. The diverticulum so created almost never yields characteristic symptoms, and for this reason it is most often diagnosed intraoperatively. Because of this, the surgeon must keep in mind the possible existence of such a diverticulum when reoperating a recidivating hernia localized in the lower abdomen especially those near the bladder. It is important that such a diverticulum be carefully dissected and that the bladder be adequately closed with a layers of catgut sutures. An accidental -- overlooked lesion of the urinary bladder during operation can have a fatal outcome. For this reason such lesions must never be overlooked, and should be resolved during the hernioplasty itself.

Diverticulum↗
PubMed1977

Spontaneous rupture of a congenital diverticulum of the right ventricle in a 1-month-old child.

Spontaneous rupture of a thin fibrous congenital subepicardial diverticulum of the right ventricle of the heart resulted in a sudden death of an 1-mth-old child. Heart catheterization with angiocardiography at 1 and 2 wk of age revealed a truncus arteriosus type A 1 with a small frontal outbulging in the level with the outflow of the right ventricle, interpreted as a blind infurdibular chamber. At autopsy this outbulging was identified as a congenital fibrous diverticulum of the right ventricle. Death was due to rupture of the diverticulum and hemopericardium. The case motivated a reviewing of the literature dealing with congenital diverticula of the right ventricle of the heart, as well as a discussion of problems with the diagnosis of the diverticulum.

Diverticulum↗
PubMed1979

[Radioisotopic diagnosis of Meckel's diverticulum in children].

The serial scintiphotography following intravenous injection of Tc99m-ertechnetate was used for examination of 50 children aged from 11 months to 14 years. The method is founded on the Tc99m-pertechnetate property of selective accumulation in the gastric mucous membrane and in Meckel's diverticulum when the latter contains the ectopic gastric mucous membrane. The inflamed diverticulum can accumulate the radionuclide, as well. Meckel's diverticulum was suspected in 7 children during examination; in 6 of them Meckel's diverticulum was found peroperatively, and in one case there was enterocyst of the ileum.

Adolescent↗
PubMed1975

[The congenital urethral diverticulum of the Male Urethra of adults].

On 4 male adults we demonstrated a congenital urethral diverticulum. The clinical symptomatology mainly showed the inflammatory micturition difficulties, while the obstructive micturtition symptomatology of the childhood was hardly registered by the patients. Injection and micturition urethrogram led to the diagnosis. The mostly additional obstructive effect of a diverticulum can be well diagnosed by urodynamic investigations (cystourethromanometry and uroflowmetry). We used the following treatment: removal of the membrane between diverticulum and urethra and resection of the urethral diverticulum with primary urethral obstruction. The advantages of an open approach in comparison to endoscopical therapy were pointed out.

Adult↗
PubMedDate not supplied

[Intraluminal diverticulum of the duodenum. Report of a case and review of published cases].

The intraluminal diverticulum of the duodenum is very rare; it is an anatomical sac like formation, located in the interior of the duodenum and communicating with it through an orifice situated a the upper pole of the diverticulum where the wall is covered by mucosa on both faces. It has interesting etiopathogenic problems. We present an observation after reviewing the corresponding literature. It was a 32-year old woman suffering from moderate epigastric pains, pyrosis, chronic constipation, markedly nervous. The epigastric pain was unrelated to food or physical efforts. The physical examination showed slight epigastric pain. The gastroduodenal radiological examination showed in the second part of the duodenum a particular image, pear-shaped, homogeneous, impregnated in barium; this image was surrounded by a radiotransparent halo which changed with the patient's position. It has been seen that the diverticulum changes in size and position in agreement with the peristaltism, without ever obstructing the passage through the duodenum. A review is made of the literature and history of intraluminal diverticulum.

Adolescent↗