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PubMed2005

Coexistence of a Meckel's diverticulum and a urachal remnant.

Meckel's diverticulum, which is a remnant of the omphalomesenteric or vitelline duct, is the most common congenital abnormality of the gastrointestinal system. Urachal abnormalities, resulting from anomalous urogenital development, are not observed frequently and case reports are mainly represented in literature. The presence of these two congenital anomalies together is a very rare pathology. Complications arising from a Meckel's diverticulum or urachal remnant may clinically mimic acute appendicitis and other surgical pathologies. We report on a patient who underwent surgery for acute appendicitis when it was discovered that the symptoms were produced by a perforated Meckel's diverticulitis. In the course of the surgery, a urachal remnant was found to coexist with the diverticulum.

Adolescent↗

PubMed2005

Prenatal diagnosis of a right ventricular diverticulum complicated by pericardial effusion in the first trimester.

A ventricular diverticulum associated with a large pericardial effusion was diagnosed at 13 weeks of gestation. The pericardial effusion resolved spontaneously by 20 weeks and the diverticular size remained the same during pregnancy. In the postnatal period the neonate underwent surgical correction of both the diverticulum and associated ventricular and atrial septal defects. Our case indicates that congenital ventricular diverticulum may be associated with a good perinatal outcome.

Adult↗

PubMed1995

Laparoscopic treatment of Meckel's diverticulum. Obstruction and bleeding managed with minimal morbidity.

We present two cases in which complication of a Meckel's diverticulum were dealt with, and in one case diagnosed using the laparoscope. One was a large bleeding diverticulum containing ectopic gastric mucosa, with the diagnosis suggested preoperatively, confirmed laparoscopically, and the pathology resected extracorporeally. The second was a partial intermittent small-bowel obstruction due to torsion around the mesodiverticular band, diagnosed and resected via the laparoscope. The literature of Meckel's diverticula and complications is reviewed, with open and laparoscopic treatment options. Although uncommon, many cases of Meckel's diverticulum may be quite suitable for laparoscopic diagnosis and treatment.

Adolescent↗

PubMed1993

Congenital anterior urethral diverticulum.

A congenital anterior urethral diverticulum is a rare abnormality. We present two adults with nonobstructing congenital wide-mouthed diverticulum and an adult with a diverticulum containing a partially obstructing distal lip. The clinical presentation, radiographic appearance, treatment, and possible etiology are described.

Adult↗

PubMed1992

[2 cases of life threatening gastrointestinal hemorrhage from Meckel's diverticulum].

Meckel's diverticulum is one of the commonest congenital anomalies of the gastrointestinal tract. Two cases requiring emergency laparotomy due to massive gastrointestinal bleeding are presented. Only at laparotomy the correct diagnosis was established. In the first case a segment of small bowel was resected and diverticulectomy was performed in the second case. Both patients are free of complaints now at 2 and 3 years of follow-up respectively. The genesis of diverticular bleeding, the difficulties of the preoperative diagnosis of the complicated diverticulum and the uncertain indication for operation in cases of uncomplicated diverticulum are discussed and the literature is reviewed.

Adolescent↗

PubMed1996

In utero appearance of a giant Meckel's diverticulum.

The authors present a case of a Meckel's diverticulum identified during a routine prenatal ultrasound examination as a complex mass, superior and posterior to the urinary bladder, that prompted meticulous postnatal evaluation. A 4.0-cm Meckel's diverticulum containing heterotopic gastric mucosa was excised before complications could arise. Meckel's diverticulum should be included in the differential of a complex intraabdominal mass of the fetus/neonate.

Female↗

PubMed1993

A case of intraduodenal diverticulum imitating choledochocele.

An intraduodenal diverticulum in 54 year old woman which caused alcalculous cholecystitis and pancreatitis is described. The diverticulum was missed at the first operation, performed for acute cholecystitis. Before the second it was interpreted as a pancreatic cyst. At the second intervention, the cyst wall was excised through a duodenotomy. Histological examination of the wall of the diverticulum is crucial for correct diagnosis.

Choledochal Cyst↗

PubMed1988

Association of Meckel's diverticulum and Crohn's disease.

A significant association between Meckel's diverticulum and Crohn's disease has been suggested in the clinical literature. Ten patients with entities demonstrated radiographically as well as cases reported in the literature were analyzed to determine the relevance of this association to radiologic evaluation. The Meckel's diverticulum in most cases was an incidental finding whereas the Crohn's disease usually accounted for the patient's clinical symptoms. Recognition of this association should prevent unnecessary laparotomy for an incidental Meckel's diverticulum and improve the radiographic diagnosis of coexistent Crohn's disease.

Adult↗

PubMed1987

Abdominal colic due to ureteric diverticulum with stone formation.

In a 15-year-old boy right lower abdominal colicky pain was caused by intermittent obstruction of the ureter by stones which had accumulated in a ureteric diverticulum. As was shown by repeated X-rays, each of these stones had moved to the ureter and back to the diverticulum. Ureteric diverticulum mostly remains asymptomatic in children: stone formation and obstruction of the ureter by the stones is one of the instances which may cause symptoms.

Adolescent↗

PubMed1984

Iron deficiency anemia caused by a giant jejunal diverticulum.

We treated a patient with a jejunal diverticulum with a rare complication of iron deficiency anemia. The anemia was improved following resection of the diverticulum. It was revealed that the iron deficiency anemia was due to the malabsorption caused by the jejunal diverticulum.

Aged↗

PubMed1999

Epiphrenic diverticulum composed of airway components attributed to a bronchopulmonary-foregut malformation: report of a case.

Bronchopulmonary-foregut malformation (BPFM), defined originally as pulmonary sequestration with or without communication to the esophagus, has been acknowledged to include congenital foregut diverticula. We present herein the case of a 43-year-old woman with a 9-year history of dysphagia, in whom a barium meal examination demonstrated a 2.5-cm epiphrenic diverticulum and several fistulae. A laparotomy was performed and the lower esophagus without communication to the lung was pulled down and resected, followed by an esophagogastrostomy carried out with fundopexy. Since her operation, the patient has been free of symptoms. Histologically, the diverticulum was observed to be lined by stratified squamous cells, but its shape was formed by mural cartilage, smooth muscle cells, and three ciliated-cell cysts. The dysphagia was considered to have been derived from the kinked esophagus created by the rigid diverticulum, being the possible developmental arrest of a supernumerary lung bud. These findings indicate that this case may involve BPFM in the broad sense. Although several cases of bronchogenic cysts located beneath or across the diaphragm have been reported as a subgroup of BPFM, congenital epiphrenic diverticula has rarely been described.

Adult↗

PubMed1991

Upper esophageal sphincterotomy in dysphagic patients with and without a diverticulum.

Symptoms of high dysphagia are sometimes too readily interpreted as symptoms of globus. When patients have unmistakable difficulties during meals, focused diagnostic procedures are indicated. The upper esophageal sphincter (UES) is the key structure at the transition from hypopharynx to esophagus. In many disorders presenting with dysphagia, the UES mechanism remains intact and can cause the symptoms. Especially in patients with a hypopharyngeal (Zenker's) diverticulum and in patients with a hypopharyngeal paralysis due to a neurologic disorder, sphincterotomy may be indicated. In the microendoscopic treatment of Zenker's diverticulum, a transmucosal sphincterotomy is created and at the same time a more ample overflow from diverticulum to esophagus is effected. In view of our results in 507 patients we are justified in maintaining that this procedure can be regarded as a safe and effective treatment. In patients with neurologic dysphagia, sphincterotomy by an external approach can ensure adequate passage of food from the hypopharynx to the esophagus, resulting in marked improvement of the dysphagic symptoms. Our technique and results of external approach sphincterotomy are described here.

Adult↗

PubMed1977

A bleeding Meckel's diverticulum diagnosed by arteriography.

A case of Meckel's bleeding diverticulum diagnosed by emergent arteriography is presented. Arteriography revealed an extravasation of contrast medium into the distal ileum and an abnormal ileal artery which passed to the antimesenteric border of the ileum. The diverticulum was demonstrated by double contrast study of the small intestine. The merits of emergent arteriography and other examinations for diagnosing Meckel's diverticulum are discussed.

Adolescent↗

PubMed2000

[Perforation of Meckel's diverticulum by a toothpick].

We report the case of a 31-year-old man with lower abdominal pain, leucocytosis and normal sonographic findings. When performing laparoscopy we found a Meckel's diverticulum perforated by a toothpick. Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. Symptoms normally occur only when there are complications, when bleeding, obstruction and inflammation are most frequent. Despite modern imaging techniques the diagnosis is difficult and often made intraoperatively. Resection should be performed in any case, because the risk of future complications of the diverticulum outweigh the morbidity after simple diverticulectomy.

Abdominal Pain↗

PubMed2004

[Zenker's diverticulum. The endoscopic-microscopic, staple-assisted esophagodiverticulostomy].

BACKGROUND: The endoscopic-microscopic staple-assisted esophagodivertikulostomy of Zenker's diverticulum is a new modification of endoscopic operation techniques which minimizes complications and is able to speed up the patient's convalescence. PATIENTS AND METHODS: A total of 22 out of 32 patients with Zenker's diverticulum underwent surgery. The operation involves cutting the wall between the diverticular sac and the oesophagus and, at the same time, closing the mucosal wound edges using the "closed" surgery method. RESULTS: All operations were effective and uncomplicated. A total of 28 operations were performed on 22 patients. The operations due to relapse were predominantly necessary among younger patients, of whom three were operated endoscopically and three through the cricopharyngeal myotomy. CONCLUSIONS: The "closed" endoscopic-microscopic staple-assisted esophagodivertikulostomy of Zenker's diverticulum avoids opening the retropharyngeal and retrooesophageal areas and allows a quick convalescence in the mostly elderly patients. This technique is effective, safe and has no major complications.

Adult↗

PubMed1997

Sonographic appearances of inverted Meckel diverticulum with intussusception.

This study illustrates the sonographic findings of inverted Meckel diverticulum acting as a lead point of an intussusception in five patients. In four patients, the inverted diverticulum was seen as a segment of blind-ending, thick-walled bowel projecting for a variable distance from the apex of the intussusceptum. The larger diverticula had a characteristic bulbous shape. The central serosal surface of the inverted diverticulum was filled with fluid in one patient, with fluid and fat in another, and with echogenic fat only in the other two. The presence of fat was confirmed by CT in one patient. The features illustrated in these four patients appear to be specific. In the fifth patient, the sonogram revealed a nonspecific echogenic mass at the apex of the intussusceptum. Recognition of these features on sonography may obviate the need for further investigation.

Child↗

PubMed2001

Axial torsion of Meckel's diverticulum presenting as a pelvic mass.

Meckel's diverticulum is the most common congenital gastrointestinal anomaly. Axial torsion of the diverticulum is rare and may produce nonspecific abdominal signs and symptoms. We describe a case of torsion of a Meckel's diverticulum that was noted as a pelvic mass on CT images.

Adolescent↗

PubMed2003

Scintigraphic evaluation of Zenker's diverticulum.

Zenker's diverticulum (ZD) is a rare pathology, with a prevalence of between 0.01% and 0.11%. Definitive diagnosis of ZD can be accomplished by contrast radiographic examination (barium oesophagogram, BE); oesophageal manometry (ME) is recommended mainly for those patients suffering from dysphagia and/or gastro-oesophageal reflux. The aims of the present study were to assess whether oropharyngo-oesophageal scintigraphy (OPES) is able (a) to visualise ZD and (2) to demonstrate the corresponding alteration in the swallowing phases. We studied 16 patients (nine male, seven female, mean age 67.4 years), and 17 healthy volunteers (ten male, seven female, mean age 53 years) as a control group. All the patients underwent ME, BE and OPES. Nine patients underwent surgery and six of them were re-evaluated after 6 months. We administered 10 ml of water with 37 MBq of technetium-99m colloid through a straw, acquiring 480 sequential images (0.125 s/frame for a total of 60 s) with the patient standing in front of the gamma camera in the 80 degrees right anterior oblique position. Two static images were performed at the end of the dynamic phase, before and after ingestion of 100 ml of unlabelled water to evaluate the presence of inflammation (persistence of radioactivity in the diverticulum or oesophagus). Study of the sequential scintigraphic images and time-activity curves permitted both qualitative (diverticulum visualisation, multiple deglutitions, reflux, presence of inflammation) and quantitative analyses [oral, pharyngeal and oesophageal transit times and retention indexes, tracheal aspiration percentage] of swallowing disorders. OPES showed a good correlation with the results of other diagnostic techniques usually performed in patients with this pathology, and especially with ME in the evaluation of oropharyngeal phase disorders. Furthermore, OPES is a sensitive and simple technique that is well tolerated and entails a low irradiation dose for patients.

Adolescent↗