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PubMed1998

[A rare case of a perforated diverticulum of the cecum].

A rare case of peritonitis by cecal perforated diverticulum which was diagnosed after surgery by histology is reported. Preoperative diagnosis is often ignored and, in rare cases, is not always clear at laparotomy. Clinical aspects, diagnostic procedures, histological picture and surgical treatment are described. In the literature diverticula are classified as "solitary" and "multiple", "congenital" and "acquired", "true" and "false" and finally "usual type" and "hidden variant". The treatment of cecal acute diverticulitis is, in the majority of patients, surgery. Simple resection of the diverticulum and suture of the breach in double layer is the elective operation of non-complicated diverticulum or with an inflamed projection from the cecal wall ("usual type"). Segmental resection of colon or "right hemicolectomy" is recommended when a precise diagnosis is not possible and in complicated diverticula ("hidden variant"). On the basis of personal experience it is underlined that diagnosis is rarely made preoperatively since the clinical picture suggests an acute appendicitis. If there are some doubts for appendicitis, a incidental tumor or possible perforated diverticulum of the cecum should be considered and urgent surgery is mandatory.

Acute Disease↗
PubMed1998

[Intestinal obstruction due to Meckel's diverticulum. Description of three cases].

Among 588 small bowel mechanical obstructions operated since January 1982 until December 1996 at the Flajani Surgery Department and Emergency Department of the San Camillo Hospital in Rome, 3 male patients were operated for intestinal obstruction due to Meckel's diverticulum. In one case, obstruction was caused by a small bowel volvulus rolling on a Meckel's diverticulum, whose gangrenous extremity was "blocked" on caecum. In the other two cases, intestinal loops were incarcerated into an internal hernial ring constituted by the same diverticulum whose inflamed extremity was fixed to corresponding mesentery. We examined embryologic and clinical aspects of the pathology here considered, particularly its complications, obstruction being the most common in adult age. Diagnosis is often misunderstood, since a complicated Meckel's diverticulum simulates many other abdominal pathologies. A straight radiography and an ultrasonography of the abdomen may be useful to reach the correct diagnosis. We performed diverticulectomy, using a linear stapler and we underline the opportunity of this method. In young age laparoscopy resection is considered the gold treatment of this pathology by some authors. We didn't observe any mortality, although one of our patients was in a severe septic condition. It is necessary to examine the last ileal 100 centimetres when a suspected acute appendicitis is not initially found by operation. The opportunity of a promptly performed operation is underlined to prevent that such a benign pathology may induce also exitus.

Adult↗
PubMedDate not supplied

Laparoscopic repair of a large symptomatic epiphrenic esophageal diverticulum.

PURPOSE: The diagnosis of symptomatic epiphrenic esophageal diverticula is uncommon. Even less common are published reports regarding the efficacy of laparoscopic repair of this malady. METHODS: We report the case of a 59-year-old male patient with Parkinsonism found to have a large, symptomatic epiphrenic diverticulum and discuss the surgical treatment performed. The patient presented with a 6-month history of worsening dysphagia to both solids and liquids, regurgitation of undigested food, and weight loss. Barium esophagram identified the presence of a large distal esophageal diverticulum. Esophagoscopy confirmed the epiphrenic location of the diverticulum and the absence of other pathology. Laparoscopic transhiatal diverticulectomy was performed utilizing a gastrointestinal endoscopic stapler. Intraoperative esophagoscopy was performed to confirm resection of the diverticulum without constriction of the lumen. RESULTS: The patient resumed intake of liquids on postoperative day 1 after a water-soluble contrast esophagram revealed no extravasation. The patient was discharged on hospital day 3. He reported residual dysphagia to solids postoperatively, which appeared to resolve after pneumatic dilation. CONCLUSIONS: We conclude that laparoscopic epiphrenic diverticulectomy is technically feasible and safe. The comorbidity of Parkinsonism adds complexity to the diagnosis and treatment of this uncommon disorder.

Journal Article↗
PubMed1998

Colonic diverticulitis: evaluation of the arrowhead sign and the inflamed diverticulum for CT diagnosis.

PURPOSE: To determine the frequency of visualization of the arrowhead sign and an inflamed diverticulum on abdominal computed tomographic (CT) scans in patients with acute colonic diverticulitis and to assess the specificity of these signs. MATERIALS AND METHODS: One hundred fifty consecutive patients suspected of having diverticulitis prospectively underwent helical CT after the administration of contrast material by means of an enema. Sixty-four patients (43%) had a final clinical diagnosis of colonic diverticulitis. Each scan was reviewed for the arrowhead sign, an arrowhead-shaped collection of contrast material within focal colonic wall thickening, and for an inflamed diverticulum, a rounded, paracolic outpouching centered within fat stranding. RESULTS: The arrowhead sign was noted at CT in 17 (27%) of the 64 patients with diverticulitis. An inflamed diverticulum was noted in 21 patients (33%) at CT, with either calcium or similar high-attenuation material in 10 (48%) of the 21 patients, soft-tissue attenuation in six patients (29%), air attenuation in four patients (19%), and barium attenuation in one patient (5%). Neither sign was demonstrated in patients with alternative conditions (100% specificity). CONCLUSION: The arrowhead sign and an inflamed diverticulum are occasional, specific CT signs of colonic diverticulitis. Their identification can add diagnostic specificity to CT of acute colonic processes.

Acute Disease↗
PubMedDate not supplied

[ASSOCIATION OF DUODENAL DIVERTICULUM PRESENCE WITH CHOLEDOCHOLITHIASIS]

OBJECTIVES: The aim of this study was to investigate in aretrospective way the frequency of duodenal diverticulum and its association with choledocholithiasis. Methods:This study included 2728 consecutive patients who underwent ERCP during the period 1993-1997. Duodenal diverticulum was discovered in 122 cases (4.5%). In 22 patients cannulation was not achieved since it was not technically possible. Results: In 100 patients with successful cannulation, 54 cases with juxtapapillary diverticulum were encountered associated with choledocholithiasis. CONCLUSION: These data suggestthat duodenal diverticulum is associated with choledocholithiasis.

Journal Article↗
PubMed1987

[Rupture of a retro-esophageal diverticulum on a right aortic arch. Apropos of a case].

Right aortic arch with retro-oesophageal left subclavian artery usually is an asymptomatic vascular abnormality. The evolutive potential of the associated retro-oesophageal diverticulum is unknown. Complications caused by the malformation are rare, but they may be extremely severe. A case of ruptured diverticulum in an adult patient is reported. The vascular abnormality, as well as the rupture, were confirmed by computerized tomography (CT) and angiography. Complications of retro-oesophageal diverticula are due to these formations being transformed into aneurysms, with compression of the oesophagus, dissection of the aorta or rupture. Such accidents raise the problems of detection of the abnormality, long-term surveillance of the diverticulum (facilitated by CT) and decision to be made when signs of transformation develop (resection of the diverticulum under extracorporeal circulation).

Aorta, Thoracic↗
PubMed1993

[Jugular bulb diverticulum mimicking Menière's disease. Surgical treatment].

The position of the jugular bulb is extremely variable. A high jugular fossa with a diverticulum of the jugular bulb can alter the inner ear function with neurosensory hearing loss, vertigo and tinnitus. Six cases of jugular bulb diverticulum with vertigo mimicking Meniere's disease were operated on and followed up from 6 months to 4 years. The jugular bulb was approached through a mastoidectomy and the diverticulum was decompressed downward using bone wax. The vertigo disappeared after surgery in all the cases. These observations suggest that an abnormality of the jugular bulb should be considered as a possible origin of Meniere's disease and that vertigo can be cured by downward decompression of the diverticulum.

Adult↗
PubMedDate not supplied

Pharyngoesophageal diverticulum complicated by squamous cell carcinoma.

Pharyngoesophageal (Zenker's) diverticulum is a relatively common acquired condition that may cause dysphagia and regurgitation of food. Squamous carcinoma may develop in such a diverticulum, but this complication is exceedingly rare and may not be suspected preoperatively. This report describes a case in which the diagnosis of squamous carcinoma was made after regurgitation of malignant tissue from a radiographically proven pharyngoesophageal diverticulum. The patient was treated by simple diverticulectomy and postoperative radiation therapy.

Carcinoma, Squamous Cell↗
PubMed1990

Surgical therapy of Zenker's diverticulum: low risk and high efficiency.

Surgery for the treatment of Zenker's diverticulum was performed at our institution in a total of 43 patients over 6 1/2 years. Cervical myotomy with diverticulectomy was performed in 32 of the patients and myotomy alone in 11. Mortality totaled 0%, with a reversible lesion of the recurrent nerve occurring in 7%. In 60% of the cases investigated preoperatively (N = 40), motility disorders of the upper esophageal sphincter (UES) could be demonstrated using manometry as well as with cineradiography in 92% of the patients. Follow-up studies in 39 of the cases 25 months (mean) postprocedure indicated 82% of the patients to be symptom-free, with the remaining 18% demonstrating a marked improvement. Postoperative manometry as well as cineradiography carried out in 12 patients revealed the presence of UES motility dyscoordination in 8% and 25%, respectively. There were, however, no signs of recurrence of the diverticulum. The high number of patients in our study group demonstrating motility disorders of the UES emphasizes the need for cervical myotomy as part of the surgical therapy for Zenker's diverticulum.

Adult↗
PubMed1992

[Cancer on an esophageal diverticulum].

Carcinoma is one of the most severe complications of oesophageal diverticula. Its incidence varies from almost zero to 4 percent. The authors report 4 cases of carcinoma arising in a pharyngo-oesophageal diverticulum and 2 cases involving a diverticulum of the oesophageal body. In this disease, the diagnosis is often delayed, which may be the reason for the low long-term survival rate. The risk of carcinoma is another justification for resection of the pharyngooesophageal diverticulum. The post-surgical morbidity of the oesophageal body diverticula is an obstacle to systematic resection of these lesions.

Adult↗
PubMed1990

[Leiomyosarcoma of the Meckel's diverticulum and multiple diverticulosis of the ileum. Apropos of a case].

We report a case of a leiomyosarcoma arising in a Meckel's diverticulum in a man of 90 years, with multiple ileal diverticulosis. The clinical picture was similar to acute appendicitis and diagnosis was not made until resection of an abdominal mass with histological appearance of leiomyosarcoma. 59 cases of leiomyosarcoma of Meckel's diverticulum have previously been reported in the literature. No case until now has been reported in a patient of Caribbean origin neither in association with ileal diverticulosis. Although rare, leiomyosarcoma is the commonest sarcoma of Meckel's diverticulum, and with full resection of the tumor the prognosis is very good.

Aged↗
PubMed1979

Surgical treatment of hypopharyngeal (Aenker's) diverticulum.

Twenty-six patients underwent surgical repair of a pharyngoesophageal diverticulum at Ochsner Clinic, New Orleans, from 1957 through 1977. The majority of the patients (22) had a one-stage excision with intraluminal packing of the diverticulum and esophageal closure after excision. Of the 22 patients whose diverticula were treated by this method, 16 reported they were asymptomatic postoperatively, and six stated their symptoms improved. There were three complications: two wound infections and a temporary recurrent laryngeal nerve paresis. During long-term follow-up, recurrent diverticula developed in two patients. The addition of packing to the diverticulum and the resection and closure over Maloney's dilator have proven to be important aids in this surgical approach.

Adult↗
PubMed1998

Minimally invasive surgery for Zenker diverticulum: analysis of results in 95 consecutive patients.

OBJECTIVE: To assess the effectiveness of transoral stapled diverticulum esophagostomy in relieving symptoms and decreasing outflow resistance at the pharyngoesophageal junction in patients with Zenker diverticulum. DESIGN: Cohort study. From April 1, 1992, until May 31, 1996, the operation was attempted in 95 patients. The median follow-up was 23 months (range, 13-48 months). SETTING: Tertiary care university hospital. PATIENTS: There were 74 men and 21 women, with a median age of 64 years (age range, 37-92 years). All complained of dysphagia and pharyngo-oral regurgitation, and 18 (20%) suffered from recurrent aspiration pneumonia. The median size of the pouch measured by flexible endoscopy was 4 cm (range, 2.5-8 cm). INTERVENTION: The septum between the diverticulum and the esophageal lumen was divided under general anesthesia using a linear endostapler introduced through a Weerda endoscope. In most patients, 2 applications of the endostapler with a modified anvil were used. Operative time averaged 23 minutes. MAIN OUTCOME MEASURES: Morbidity, symptom score, patient's satisfaction, videofluorographic barium transit, hypopharyngeal intrabolus pressure, upper esophageal clearance of radioisotope. RESULTS: A switch to open surgery was required in 3 patients (3.1%), due to difficult exposure of the common wall in 2 cases and a mucosal tear in the other. No postoperative morbidity or mortality was recorded. Oral feeding was started the following day and the median hospital stay was 3 days (range, 2-8 days). Five patients complained of persistent symptoms; 3 of them underwent another endosurgical operation, 1 underwent laser treatment by means of flexible endoscopy, and 1 eventually required open surgery. All patients are asymptomatic at the latest follow-up visit. Postoperative radiologic studies showed free flow of barium in all patients. Manometry showed a significant reduction of hypopharyngeal intrabolus pressure over preoperative values (P=.003). Radionuclide studies showed a significant reduction of upper esophageal residual activity at 1 minute compared with preoperative values (P=.006). CONCLUSIONS: Endosurgical approach to hypopharyngeal diverticula larger than 2 cm is safe and effective. Symptom relief, elimination of the pouch, and decreased outflow resistance at the pharyngoesophageal junction can be obtained without morbidity and with a short hospital stay.

Adult↗
PubMed1979

Meckel's diverticulum of the proximal jejunum.

There are no well-substantiated reports, to our knowledge of a Meckel's diverticulum arising outside the limits of the terminal ileum. We saw a diverticulum located in the proximal jejunum that fulfilled the anatomic and histologic criteria for the diagnosis of a Meckel's diverticulum. This was an incidental finding during the treatment of a sliding esophageal hiatus hernia and caused no apparent difficulty to the patient.

Gastroesophageal Reflux↗
PubMed1992

Foreign bodies within a Meckel's diverticulum.

Although complications of Meckel's diverticula are relatively common, there has not been a reported case, to our knowledge, of foreign bodies impacted within a Meckel's diverticulum. We report herein a case of a 2-year-old child who had two pennies trapped in a Meckel's diverticulum. This case demonstrates that foreign objects in the right lower quadrant that do not progress may be impacted in a Meckel's diverticulum.

Acute Disease↗
PubMed1997

Microendoscopic treatment of the hypopharyngeal diverticulum with the CO2 laser.

BACKGROUND AND OBJECTIVE: The hypopharyngeal (Zenker's) diverticulum is a herniation of mucosa and submucosa on the posterior wall of the pharynx. The only treatment is surgical. STUDY DESIGN/MATERIAL AND METHODS: Between 1976 and 1993, 109 patients with a hypopharyngeal diverticulum were operated on at the Department of Otorhinolaryngology, Head and Neck Surgery, University of Kiel, either transcutaneously combined with a cricopharyngeal myotomy (n = 76), or microendoscopically (n = 37) using the CO2 laser. Results and complications of both techniques were evaluated and compared. RESULTS: With both surgical procedures, > 90% of the patients were treated successfully. The rate of postoperative complications was generally low. In comparison to the microendoscopic procedure, serious complications were found to be more frequent in patients treated with the conventional transcutaneous diverticulectomy. CONCLUSION: The laser surgical tissue bridge dissection is a less invasive, quick, relatively safe, and effective procedure requiring only short hospitalisation. Therefore, the laser surgical tissue bridge dissection can be considered as the method of choice for the treatment of the hypopharyngeal diverticulum.

Adult↗
PubMed1976

Complications of Meckel's diverticulum.

This paper reviews the presentation and surgical pathology of 50 Meckel's diverticula encountered in one hospital in a 20-year period. It is concluded that in children with intestinal bleeding or a "raspberry tumour" of the umbilicus a Meckel's diverticulum is usually suspected. In adults with an acute surgical emergency Meckel's diverticulum is unlikely to be considered. However, a Meckel's diverticulum can give rise to surgical problems in many ways and at any age. In particular, the possiblity of an attached mesodiverticular band leading to obstruction must be stressed.

Acute Disease↗
PubMed1985

Meckel's diverticulum in the adult.

Meckel's diverticula were removed from 49 adult patients during a 15 year period. In 24 (49 per cent) of the patients the diverticulum was the cause of symptoms while in the remaining 25 it was an incidental finding at laparotomy. Of the symptomatic patients, 10 had acute inflammation of their diverticula, 8 presented with small bowel obstruction (in 4 cases due to fibrous bands) and 4 attended because of gross rectal bleeding; of the 2 remaining patients one was found to have intussusception of Meckel's diverticulum into the terminal ileum whilst the other had a nodule of calcified material lying within a partly gangrenous vitellointestinal duct. There was no operative mortality in the series. Heterotopic tissue was noted histologically in six Meckel's diverticula, all of which produced symptoms. The importance of considering a diagnosis of Meckel's diverticulum in the young adult presenting with acute small bowel obstruction or rectal bleeding is emphasized.

Adolescent↗