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PubMed1991

Radiofrequency catheter ablation for Wolff-Parkinson-White syndrome associated with a coronary sinus diverticulum.

The case of a patient with Wolff-Parkinson-White syndrome undergoing attempted radiofrequency catheter ablation of a left posterior paraseptal accessory pathway is described. Coronary sinus venography revealed the presence of a large diverticulum attaching near the os. The electrogram recorded from a catheter placed in the narrow neck of the diverticulum revealed a very short atrioventricular time during sinus rhythm. The pathway was easily ablated using radiofrequency energy applied in the neck of the diverticulum, after multiple failed attempts at catheter ablation from the endocardial surface of the mitral annulus. Our report emphasizes the importance of searching for a coronary sinus diverticulum in all patients with posterior accessory pathways undergoing catheter ablation.

Adult↗
PubMed1999

Small intestinal ulceration secondary to carcinoid tumour arising in a Meckel's diverticulum.

A solitary small intestinal ulcer associated with a carcinoid tumour in a nearby Meckel's diverticulum was found in a 77 year old man presenting with massive rectal bleeding. Angiography and a radioisotope study localised the bleeding to the ileum. At operation, the Meckel's diverticulum was identified, with bleeding from an ulcer just distal to it. Pathological examination revealed a small carcinoid tumour confined to the Meckel's diverticulum. Close to the opening of the diverticulum, within the ileum, a well demarcated ulcer was present. Histology showed a non-specific ulcer which eroded a large blood vessel. This is the first documented occurrence of solitary small intestinal ulceration in association with a carcinoid tumour. Carcinoid tumour should be added to the list of possible causes of small intestinal ulceration. The ulceration may be secondary to release of cytokines by the tumour.

Aged↗
PubMed1984

Ventricular diverticulum.

A ventricular diverticulum was found on computed tomography in six out of 25 cases of congenital obstructive hydrocephalus. In all six cases, the diverticulum was located on the medial wall of the trigone. In three cases, it was restricted to the tentorial hiatus with a recognisable superior cerebellar cistern (small). In two cases, it occupied the tentorial hiatus without a recognisable cistern (medium). The remaining case had a diverticulum extending into the posterior fossa that caused cerebellar ataxia (large). In all patients, the diverticulum regressed after ventriculo-peritoneal shunt. The characteristics of the computed tomograms, the clinical significance and the pathogenesis of this phenomenon are discussed.

Brain Diseases↗
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↗
PubMed1996

Inverted Meckel diverticulum: clinical, radiologic, and pathologic findings.

PURPOSE: To determine the clinical, radiologic, and pathologic findings of inverted Meckel diverticulum by retrospectively reviewing a large series of cases. MATERIALS AND METHODS: Among 84 cases of Meckel diverticulum, 18 (21%) were found at surgery to be inverted into the lumen of the bowel. Thirteen of these 18 (72%) cases were associated with small bowel intussusception and five (28%) were not. RESULTS: All 18 patients (median age at time of diagnosis, 32 years) were symptomatic, but the symptoms were subacute or chronic in 14 (78%). At barium examination in 15 cases, inverted diverticulum was depicted in 10 (67%) as a solitary, elongated, smoothly marginated, often club-shaped intraluminal mass in the distal ileum. At computed tomography (CT) in three cases, a central area of fat attenuation was surrounded by a thick collar of soft-tissue attenuation. At ultrasound (US) in two cases, a target-like mass contained a central area of increased echogenicity. At pathologic examination in all cases, the inverted sac contained mesenteric fat. CONCLUSION: Inverted Meckel diverticulum occurs more commonly than previously recognized and is associated with characteristic findings at barium examination, CT, and US.

Adolescent↗
PubMedDate not supplied

Zenker's diverticulum.

Zenker's diverticulum is a pouch protruding posteriorly above the upper esophageal sphincter, in the Killian's triangle, an area of relative weakness. Zenker's diverticulum was thought, for many years, to occur as a result of cricopharyngeal incoordination but more recent evidence points to poor upper sphincter compliance with diminished sphincter opening and increased hypopharyngeal pressures. Small Zenker's diverticula may be asymptomatic. As they become larger, symptoms include dysphagia, food regurgitation, and a sensation of globus. The best diagnostic method is a barium swallow with attention to the cricopharyngeal area. Although gastroesophageal reflux may be responsible for many throat symptoms, the relationship of reflux to the pathogenesis of Zenker's diverticulum is speculative. The treatment of Zenker's diverticulum is surgical. There have been many variations in technique over the years. Diverticulectomy with cricopharyngeal myotomy remains the most frequently performed operation. Endoscopic treatment with or without laser stapling has been reported but is not popular in the United States.

Humans↗
PubMed1987

Vesicourachal diverticulum in association with other urological anomalies.

The vesicourachal diverticulum in association with other urological anomalies is a rare condition. It is easily demonstrated by ultrasound examination. We report a rare case of vesicourachal diverticulum in association with a large posterior bladder diverticulum; the latter obstructing the trigone of the bladder, and with the ureter of a right solitary ectopic and hydronephrotic kidney draining into it. Diagnosis was initially made by ultrasound and later confirmed by cystography. A CT examination was also supplementary. The literature on vesicourachal diverticulum is briefly reviewed.

Abnormalities, Multiple↗
PubMedDate not supplied

Malignant stromal tumor consistent with fibrosarcoma arising from Meckel's diverticulum. Clinicopathological study of an incidentally discovered tumor and review of the literature.

The authors report a case of a Meckel's diverticulum mesenchymal tumor incidentally discovered in a 69-year-old woman undergoing laparotomy for an ovarian cyst. Histological examination of the tumor revealed a fasciculated proliferation of spindle cells that proved to be immunoreactive to vimentin only; pleomorphism was mild, necrosis extensive and mitotic count high. Because these features were consistent with those of fibrosarcoma, the tumor was classified in the category of gastrointestinal stromal tumors; more specifically, it was considered malignant for the presence of spread beyond the primary site in the form of peritoneal nodules and for the high mitotic count. We have been able to find only one previously reported case of mesenchymal malignant tumor of Meckel's diverticulum classified as fibrosarcoma among the 199 malignant tumors described in the literature. Based on this personal experience and on the review of the literature concerning malignant tumors of Meckel's diverticulum, we discuss both the rarity of these tumors and the importance of removing Meckel's diverticulum every time it is found during laparotomy.

Aged↗
PubMed2000

Radiofrequency catheter ablation of a concealed atrioventricular accessory pathway associated with a coronary sinus diverticulum.

A 31-year-old woman underwent radiofrequency catheter ablation of a concealed left posteroseptal accessory pathway associated with a coronary sinus diverticulum. The patient had previously undergone unsuccessful catheter ablation of the posteroseptal region of the mitral annulus. Coronary sinus venography revealed the presence of the diverticulum near the ostium. An electrogram in the neck of the diverticulum showed the shortest ventriculoatrial conduction time and a large accessory pathway potential during atrioventricular reciprocating tachycardia. The pathway was successfully ablated within the neck of the diverticulum. The findings in this case underscore the importance of coronary sinus venography before ablation.

Adult↗
PubMed1996

Meckel's diverticulum: imaging diagnosis.

Despite the availability and wide use of modern imaging techniques, the diagnosis of Meckel's diverticulum is difficult. The signs and symptoms vary from none to those of an acute abdomen or gastrointestinal bleeding. Findings on physical examination may be inconsistent because of the variable location of the diverticulum, and bleeding may occur with no appreciable physical findings. Finally, small diverticula are often concealed by overlying small-bowel loops on routine small-bowel barium studies. The purposes of this article are to review the use of available techniques for the imaging diagnosis of Meckel's diverticulum, to discuss the relative advantages and indications for the various procedures, and to emphasize the role each plays in specific clinical circumstances. The embryology, anatomy, and clinical presentation of Meckel's diverticulum are also briefly discussed.

Humans↗
PubMed1998

Meckel's diverticulum: angiographic findings in 16 patients.

OBJECTIVE: The purpose of this study was to assess the sensitivity of angiography in revealing the vitellointestinal artery or other arteriographic abnormalities in patients in whom surgery subsequently proved Meckel's diverticulum. MATERIALS AND METHODS: From the 36 patients who had undergone a Meckel's diverticulectomy between 1980 and 1997 at Hammersmith Hospital or a referring hospital, we selected 18 who had undergone preoperative angiography at our institution. Case notes and angiograms of these 18 patients were reviewed for the presence of a persistent vitellointestinal artery or other angiographic evidence of a Meckel's diverticulum. RESULTS: Angiograms of 16 of 18 patients were available for review. A striking male preponderance existed (male:female = 13:3). Mean age was 28 years (range, 12-65 years). In 11 (69%) of the 16 patients, a persistent vitellointestinal artery was seen that had been noted at the time of the study and reported before surgery for nine patients. Other angiographic abnormalities at the site of the Meckel's diverticulum were present in four patients and included a vascular blush, early venous return, and arterial irregularity. CONCLUSION: Angiography will show a persistent vitellointestinal artery in most individuals with a Meckel's diverticulum who present with chronic gastrointestinal bleeding. However, the recognition of a persistent vitellointestinal artery may be difficult because of overlying vessels, and superselective catheterization of distal ileal arteries may be necessary.

Adolescent↗
PubMedDate not supplied

The hypopharyngeal diverticulum. A simultaneous cineradiographic and manometric examination.

The upper esophageal sphincter (UES) was studied in 10 patients with symptomatic hypopharyngeal diverticulum during rest and at deglutition using simultaneous cineradiography and manometry by means of triple pressure microtransducers. In all 10, cineradiographic examinations were performed. Occurrence of double pressure peaks was examined in 8/10. In 7/10, the length and resting pressure of the UES could be determined. In 5/10, the UES pressure could be recorded when the bolus was in the pharynx and in 6/10 when it reached the UES. The pressure below the neck of the diverticulum at the time when the bolus reached the diverticular entrance, was of the same magnitude or exceeded the resting pressure of the UES in 4 patients and was approximately 0 kPa in 2 patients. In 3 patients the UES contraction was elicited as soon as the bolus entered the pharynx and remained so till it had passed the UES. In 3 patients the contrast bolus was seen to pass simultaneously into the diverticulum and into the esophagus, even though the sphincter was contracted. It is plausible that the pharyngeal wall gives way when a bolus is forced against the contracted UES by the high peristaltic pressure forming a pulsion diverticulum as postulated already by Zenker in 1878. Double pressure peaks were registered in the UES at rest in 6 patients indicating a split between the muscle bundles in the sphincter.

Aged↗
PubMed2005

Intraductal papillary mucinous adenoma that arises from pancreatic heterotopia within a meckel diverticulum.

Neoplasia is an unusual complication of Meckel diverticulum. Most tumors of Meckel diverticulum are neuroendocrine or mesenchymal in origin. Adenocarcinomas represent a minority of the tumors that arise in Meckel diverticulum and are generally thought to develop from either endogenous small intestinal epithelium or heterotopic gastric epithelium. Despite the presence of ectopic pancreas in a small fraction of Meckel diverticula, convincing evidence of tumors that arise from heterotopic pancreatic exocrine tissue has not been described in this setting. Intraductal papillary mucinous neoplasms are relatively uncommon tumors of pancreatic ductal epithelial cells that line the main pancreatic duct or its major side branches. We present an unusual case of an intraductal papillary mucinous neoplasm that arose in a heterotopic pancreas within a Meckel diverticulum.

Adenocarcinoma, Mucinous↗
PubMed2001

[Hydronephrosis caused spontaneous evacuation of many small calculi in a caliceal diverticulum: a case report].

We experienced a curious case that hydronephrosis had caused spontaneous evacuation of calculi in a caliceal diverticulum. A 50-year-old woman was visited to our department complaining of right lower abdominal pain. Several right ureteral stones, right hydronephrosis and a great numbers of small round-shaped calculi in a right caliceal diverticulum were diagnosed. Many of the calculi moved from the diverticulum to ureter, and were evacuated spontaneously. The month after, the right hydronephrosis had already subsided and almost all of the calculi had disappeared. It was supposed that a hydronephrosis had widened the narrow channel between the diverticulum and the calyx and enabled the small calculi to pass through. Recent reports show that effectiveness of ESWL for symptomatic caliceal diverticular calculi is doubtful, because the narrow channel hinders the passage of stone fragments. However, this case suggests that an artificial hydronephrosis created by retrograde occlusion ureteral balloon catheter may lead to good drainage of gravel and better stone-free rate of caliceal diverticular calculi treated by ESWL.

Diverticulum↗
PubMed2004

Color Doppler sonographic findings of inflamed and perforated Meckel diverticulum.

OBJECTIVE: To describe color Doppler sonographic findings in 2 cases of inflamed and perforated Meckel diverticulum. METHODS: Two patients with inflamed and perforated Meckel diverticulum underwent color Doppler sonographic studies. RESULTS: Gray scale sonographic examination identified a fixed cystlike structure with a gut signature surrounded by a hyperechoic layer. Color Doppler sonography revealed hyperemia in the diverticular wall and hyperechoic layer, which was more intense in 1 patient. CONCLUSIONS: Identification of a fixed cystlike structure with a gut signature and wall hyperemia suggests the diagnosis of inflamed Meckel diverticulum; when a hyperechoic layer surrounds this structure, perforation of the diverticulum should be suspected.

Acute Disease↗
PubMed1999

[Congenital ventricular diverticulum in a neonate: anesthetic considerations].

Congenital diverticulum of the ventricle is a rare cardiac malformation and the reports of its surgical repair are scarce. We experienced anesthesia for a neonate with an isolated congenital left ventricular diverticulum diagnosed in utero. A male infant presented with ventricular arrhythmias and congestive heart failure. At 9 days of life the resection of the diverticulum was performed under moderately hypothermic cardio-pulmonary bypass (CPB) Major anesthetic considerations include the possible life-threatening arrhythmias, cardiac failure due to diverticulum and cardiac dysfunction after resection. Premature ventricular contractions were noted before CPB but greatly decreased under anesthesia. The operation was performed safely and arrhythmias disappeared completely after resection. Intra- and post-operative course was uneventful without any sign of cardiac dysfunction.

Anesthesia, Inhalation↗
PubMed1999

[Congenital urethral diverticulum in adults].

OBJECTIVE: To report an additional case of congenital urethral diverticulum that was incidentally discovered in an adult patient that presented with prostatic syndrome. METHODS: The clinical features diagnosis and treatment of this urethral anomaly are discussed. RESULTS/CONCLUSIONS: Congenital urethral diverticulum is an uncommon finding that usually requires treatment only if it is large or causes important symptoms. The patient described herein had a small urethral diverticulum that did not require treatment. However, the dome of the diverticulum was ruptured during urethrocystoscopy, thus facilitating drainage.

Aged↗
PubMedDate not supplied

Perforated duodenal diverticulum: report of two cases.

Duodenal diverticula may be complicated by diverticulitis, perforation, hemorrhage, pancreatitis, or biliary obstruction. Two cases of perforated duodenal diverticulum are reported. Both patients were elderly females. Computed tomography of the abdomen showed retroperitoneal air around the duodenum in the first case, and an enterolith in a duodenal diverticulum and a retroperitoneal abscess in the second case. Laparotomy and diverticulectomy with two-layer closure of the duodenum was performed in the first case. The second patient was treated conservatively with antibiotics, percutaneous abscess drainage, and endoscopic lithotomy. Both recovered well. Computed tomography is useful in the diagnosis of a perforated duodenal diverticulum. Although surgical intervention is the standard treatment, conservative therapy is also an option. Duodenal enteroliths are rare but may cause perforation of a diverticulum or biliary obstruction. The duodenal blind loop created by a Billroth II gastrectomy provides a static environment for the formation of enteroliths in duodenal diverticula.

Abdominal Abscess↗