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PubMed1991

[Results of surgical therapy of cervical diverticulum].

Eighteen patients with a pharyngoesophageal diverticulum were operated on at the University Department of Surgery, Mainz, between September 1985 and July 1990. Results are based on follow-up studies of 15 patients. Three patients were operated upon less than six months ago. All patients underwent excision of the diverticulum and a cricopharyngeal myotomy. The mean age was 69 (49-84) years and the average follow-up interval was 30 (6-52) months. Twelve of the fifteen patients are free of symptoms concerning the esophagus since the operation. Two patients who died 17 resp. 22 months after the operation were also free of symptoms concerning the esophagus. In all 11 patients who had a barium contrast, swallowing was normal and no recurrence was found. The results show excision of the diverticulum combined with a cricopharyngeal myotomy to be an effective method with low risk for the long-term removal of pharyngoesophageal diverticulum.

Aged↗
PubMed1990

[Congenital esophagobronchial fistula communicated to esophageal diverticulum, report of a case].

We encountered a successful repair of congenital esophagobronchial fistula communicated to esophageal diverticulum. A 35 year-old-female has had frequent episodes of pneumonia since her 1st delivery. Barium esophagogram revealed a fistulous tract between the esophageal diverticulum and the right lower lobe bronchus. Bronchogram showed a ectatic dilatation at B6a and B6c. The resection of diverticulum and right lower lobectomy including the removal of fistulous tract were carried out. Histological examination of the resected fistula revealed a smooth connection between squamous epithelium and columnar epithelium. And muscularis mucosa was maintained with no evidence of inflammatory changes. So this case was diagnosed a Braimbridge I type esophagobronchial fistula. In Japan 21 cases of congenital esophagobronchial fistula with diverticulum have been reported. It is assumed that three histological findings as mentioned above is important for the diagnosis of congenital esophagobronchial fistula.

Adult↗
PubMed1990

[Congenital esophageal diverticulum].

The congenital or acquired variety of esophageal diverticulum is a rare childhood disease. Reported is a case-study which deals with a five year old patient who arrived at our hospital complaining of a constricture at the cricopharyngeal level. A month later he returned to the hospital with dysphasia and regurgitation; the X-rays and endoscopic diagnosis showed stenosis of the esophagus and the presence of an esophageal diverticulum. Esophageal dilatations were carried out until an acceptable esophageal diameter was reached. Later on, the surgical removal of the diverticulum was performed without any complications. The histopathological study showed the congenital nature of the diverticulum. The patient's recovery went well and is currently considered as cured.

Child, Preschool↗
PubMed1990

[Gastrointestinal bleeding and ascending biliary infection secondary to duodenal diverticulum].

We describe a 77-year-old man with recurrent upper gastrointestinal tract bleeding and ascending biliary infection secondary to a duodenal diverticulum. Although such diverticula are relatively common, the great majority are asymptomatic and are only discovered incidentally. Only 1% manifest clinically, usually secondary to a variety of complications such as bleeding, perforation, ascending biliary infection or pancreatitis. Most often the diagnosis is made by exclusion, which accounts for the usual delay in starting treatment. When present, one must consider the possibility that the duodenal diverticulum may be responsible for the patient's symptoms. The preferred approach to a bleeding diverticulum is complete excision, while bypassing the diverticulum by Roux-en-Y duodenojejunostomy is the operation of choice for pancreaticobiliary complications.

Aged↗
PubMed1990

[A case of nephrogenic adenoma in the female urethral diverticulum].

A case of nephrogenic adenoma in the female urethral diverticulum is reported. A 39-year-old woman visited our hospital with the chief complaint of perineal pain. Observation of her perineum and transvaginal digital examination revealed urethral diverticulum, and then diverticulectomy was performed. Histological diagnosis was urethral diverticulum associated with nephrogenic adenoma. In Japan, this is the 1st report of nephrogenic adenoma arising in the female urethral diverticulum. We reviewed 305 cases of nephrogenic adenoma of the urinary tract in the English and Japanese literature.

Adenoma↗
PubMed1990

Meckel's diverticulum: report of two cases and review of the literature.

Meckel's diverticulum is considered the most common diverticulum of the small intestine. Of the various complications associated with this condition, intestinal obstruction is one of the most common. Rapid diagnosis and treatment are essential. Resection of the obstructing element is the treatment of choice. The authors report on their recent experience with two patients with Meckel's diverticulum, both of whom had intestinal obstruction as the presenting complication. The authors discuss the etiology and various complications of Meckel's diverticulum and present information on the frequency of associated mortality and morbidity.

Child, Preschool↗
PubMedDate not supplied

[Carcinoid of Meckel's diverticulum. Report of a case and review of the literature].

The presence of carcinoid tumor in a Meckel's diverticulum is a rare entity. This report describes a 56-year-old man who was admitted to hospital with symptomatic gallbladder stones. At laparotomy the gallstones were confirmed and routine exploration of the peritoneal cavity identified a small bowel diverticulum about 60 cm of the ileocecal valve. Cholecystectomy and resection of a small bowel segment containing the diverticulum were performed. Histology revealed carcinoid tumour in Meckel's diverticulum.

Carcinoid Tumor↗
PubMed1990

Recurrent hemorrhage from an invaginated Meckel's diverticulum in a 78-year-old man.

Complications arising from Meckel's diverticulum are uncommon in adults and are seldom, if ever, seen in the elderly. When they do occur in adults, intestinal obstruction or inflammation is the usual mode of presentation, hemorrhage being much less common. The patient described in this case report was 78 yr old, presented initially with iron deficiency anemia and, later, developed severe acute hemorrhage. The cause of the hemorrhage was ulceration at the tip of an invaginated Meckel's diverticulum. The ulceration was not peptic in origin, as is usually the case in similar presentations in children, no ectopic oxyntic mucosa being detected in the diverticulum of our patient. In previous reports, invaginated Meckel's diverticula have always been accompanied by intussusception, and abdominal pain has been an important part of the symptom complex in such patients. Our patient had no abdominal pain, and no intussusception was noted at surgery. This case emphasizes the need for considering a Meckel's diverticulum as the source of acute or chronic hemorrhage, irrespective of the patient's age. The utility of radionuclide blood pool imaging in arriving at a diagnosis in these cases is discussed.

Aged↗
PubMed1990

[Meckel's diverticulum in childhood].

For a period of 12 years (1977-1988) 64 children with Meckel's diverticulum (32 boys and 32 girls) have been operated. In early childhood (younger than 3 years) were 14.1 per cent; most of the others (59.4 per cent) were in school age. Complicated Meckel's diverticulum had 31.2 per cent of the children, the most common complication being intestinal obstruction--65 per cent (intussusception 25 per cent, strangulation 25 per cent and volvulus 15 per cent). Acute diverticulitis was found in 25 per cent of the complicated cases. In the clinical picture of these complications lacked cause-pathognomonic symptoms. The Meckel's diverticulum was removed in 60 children (93.8 per cent) the operation was cuneiform resection of the diverticulum in 96.6 per cent of the operated children. Only one child (1.7 per cent) had postoperative complication. All others were discharged from the clinic in full surgical repair. Practical inferences were made, based on analysis of the clinical case material.

Adolescent↗
PubMed1989

[Surgical treatment of Meckel's diverticulum].

The author analysed the results of operations on 19 patients with emergency diseases of the abdominal organs caused by pathological processes in Meckel's diverticulum. The inflammatory process in the diverticulum led to acute obstruction of the small intestine in 12, acute diverticulitis in 5, and peptic ulcer complicated by perforation of the intestinal wall in 2 patients. Two patients died in the postoperative period from progressing peritonitis. It was established that Meckel's diverticulum may occur in any area of the small intestine. Meckel's diverticulum detected during planned laparotomy must be resected.

Acute Disease↗
PubMed1989

[Hernial strangulation of Meckel's diverticulum: Littre's hernia. Apropos of 4 cases].

Hernial strangulation of Meckel's diverticulum (Littre's hernia) is a rare anatomoclinical form. It represents 10% of all complications of Meckel's diverticulum (8.8% of our cases), and complications like hemorrhage, perforation and diverticulitis are fairly frequent. Four cases of Littre's hernia are presented: two males and two females, with an average age of 67 years (range 50-83 years), representing 0.08% of all the inguinal-crural hernias operated in the department. The clinical manifestations were those of intestinal obstruction because a mixed type Littre's hernia was involved, with compromise of the diverticulum and its intestinal loop. Preoperative diagnosis is unlikely in strangulation without disturbances in the intestinal transit and, in fact, is even less likely if it is accompanied by obstruction. The diagnosis is thus almost always intraoperative. The correct treatment is surgery after restoring the patient's hemodynamic equilibrium. Simple and/or loop diverticulectomy via herniotomy, herniolaparotomy or laparotomy are debated. We think that this disorder can generally be resolved using the inguinal approach, as in any strangled hernia, with the technical option of using a larger, more comfortable and safer approach in cases of important obesity and/or deterioration of the loop (necrosis, perforation). In elderly patients with uncomplicated Littre's hernia and Meckel's diverticulum, abstention from diverticular exeresis may be justifiable. Of the four patients, the first two died from cardiogenic shock and pulmonary embolism, respectively; the last two evolved well (except for a wound abscess).

Aged↗
PubMed1989

Meckel's diverticulum in the pediatric surgical population.

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. We reviewed our experience with 31 cases of Meckel's diverticulum in children from 1966 to 1987. Twenty-four patients presented with clinical manifestations: ten from bleeding, ten from obstruction, and four from diverticulitis. Seven Meckel's were incidental findings at laparotomy. Fifty percent of the patients with bleeding had abdominal pain and 100% had ectopic gastric mucosa in the Meckel's. In six cases the technetium scan identified the Meckel's; there was one false negative scan. Obstruction secondary to a Meckel's diverticulum was due to an internal hernia in five and to intussusception in five. Three patients with intussusception had concomitant bleeding. Diverticulitis was clinically similar to appendicitis. There were no complications and no deaths following surgical resection of Meckel's diverticulum.

Child↗
PubMed1989

[The pathology of Meckel's diverticulum].

Sixteen cases of Meckel's diverticulum are reported, 14 of them detected during emergency operative intervention for acute surgical abdomen and 2 during planned operation. The complicated forms of Meckel's diverticulum were 10: acute diverticulitis 4 (25 per cent), intestinal obstruction 4 (25 per cent), neoplastic process 1 (6.25 per cent), intestinal hemorrhage 1 (6.25 per cent). Symptom-free were 43.75 per cent of the diverticuli. The clinical symptoms of acute diverticulitis resembled much those of acute appendicitis. The method of choice for its surgical management is cuneiform resection of the intestinal wall at the site of the diverticulum and transverse reconstruction of the intestinal lumen. Cancer of the diverticulum requires extended intestinal resection.

Abdomen, Acute↗
PubMed1986

[Bladder diverticulum at an atypical site].

An atypically located diverticulum of the bladder was found in five anatomical dissection specimens. The diverticulum with a depth of about 1-3 cm developed in the bladder's lateral wall. The diverticulum seems to be caused by a strong fibrous cord originating from the bladder's wall and penetrating the canalis obturatorius. Within the channel the cord is anchored by a voluminous fat body. Histologically the wall of the diverticulum reveals typical signs of chronic inflammation.

Adipose Tissue↗
PubMed1987

[Zenker's diverticulum--diagnosis and therapy].

Clinical, x-ray and endoscopic follow-up of patients operated on for Zenker's diverticulum (pharyngo-oesophageal diverticulum) via myotomy and diverticulectomy permits conclusions in respect of functional results of this therapeutic concept and the preoperative diagnosis that our study has proved to be necessary. Usually the diagnosis can be made on the basis of the characteristic anamnesis. It is confirmed by means of an oesophagogram, if necessary with a gastrointestinal passage. Besides visualisation of Zenkers diverticulum, attention must be paid especially to associated neuromuscular functional disturbances of the oesophagus. Preoperative endoscopy is necessary in individual cases only. In respect of therapy, it appears mandatory to perform a sufficiently extended (3-5 cm) myotomy of the pars transversa musculi cricopharyngei because of the frequently seen disturbance of coordination of the pharyngo-oesophageal sphincter, besides removing the diverticulum.

Diagnosis, Differential↗
PubMed1987

[Primary carcinoma in a diverticulum of the bladder: a report of two cases].

Two cases of carcinoma in a diverticulum of the bladder were experienced. The first case was of a 50-year-old male who presented in February, 1981, complaining of asymptomatic microhematuria. The excretory urogram revealed a diverticulum in the left lateral aspect of the bladder which was causing shift of the lower ureter to the median side. The cytology report of voided urine was class III. Diverticulectomy was performed and pathologic findings was a transitional cell carcinoma, grade 1, stage 0. The patient has been free of recurrence for the past 54 months. The second case was of a 67-year-old male with the chief complaint of pollakiuria. Non-papillary tumor in a diverticulum of the bladder was found by cystoscopy and computed tomography. Tumor biopsy and urinary diversion by ileal conduit were performed in the usual manner. The pathologic finding was transitional cell carcinoma of grade 11 malignancy. The patient died of intestinal obstruction on January, 19, 1984, about 15 months after the surgery. The 117 cases of carcinoma in a diverticulum of the bladder we found in the Japanese literature are reviewed briefly.

Aged↗
PubMed1988

[Congenital anterior urethral diverticulum: report of a case].

A case of congenital urethral diverticulum is reported. A 6-month-old male was admitted with difficulty to urinate and swelling of the base of penile shaft. Anterior urethral diverticulum was demonstrated by means of retrograde urethrography. A diverticulectomy combined with cystostomy was performed under the general anesthesia. Although the histological findings were insufficient to determine whether the urethral diverticulum was congenital or acquired, the former was strongly suspected judging from his clinical course. He developed urethrocutaneous fistula, one of the most common postoperative complication, on the 7th post-operative day. A complete cure of the fistula was achieved by the conservative treatment. We collected and analyzed 49 cases of congenital anterior urethral diverticulum of male children in Japan.

Diverticulum↗
PubMed1985

[Left ventricular diverticulum: a report of two cases].

Left ventricular diverticulum is a rare congenital cardiac malformation, and is classified as muscular and fibrous. Muscular diverticula are usually associated with thoracoabdominal defects and arise from the cardiac apex. We encountered two cases of muscular left ventricular diverticulum without other congenital anomalies during the review of 3,000 left ventriculograms. Both patients were men and their diverticula were located along the inferior left ventricular wall. No symptoms were associated with the diverticula. In both cases, two-dimensional echocardiography detected the diverticula, thus this is regarded as a useful method for the diagnosis and screening of this anomaly. In one of our cases, thallium myocardial imaging also demonstrated a characteristic abnormal bulge corresponding to the diverticulum. We subsequently detected two more cases of muscular left ventricular diverticula among 300 left ventriculograms. Thus, we detected four cases of left ventricular diverticula among 3,300 left ventriculograms. Although only 11 cases of muscular left ventricular diverticulum previously have been reported, this anomaly is not so rare as previously supposed, and it should be distinguished from left ventricular aneurysm.

Adult↗