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The previous reports concerning the computed tomographic (CT) appearances of small bowel diverticulum are usually limited to those of diverticulitis. We present the CT findings of uncomplicated, large small bowel diverticulum in five patients. An interesting coexistence of large small bowel diverticulum and small bowel volvulus will be mentioned. Four patients had recurrent abdominal pain in the past 2 years.
Meckel's diverticulum is the most common congenital gastrointestinal anomaly. (99m )Technetium pertechnetate imaging (Meckel's scan) is the best noninvasive method used to diagnose this condition when heterotopic gastric mucosa (HGM) is present. Although cimetidine enhancement has been shown to improve sensitivity of the Meckel's scan, ranitidine enhancement has also been advocated; however, this recommendation is based on unpublished data. Thirty-seven children with confirmed Meckel's diverticulum were reviewed retrospectively. Of eight children with HGM in the Meckel's diverticulum who presented with profuse rectal bleeding and underwent the conventional Meckel's scan, three of them (37.5%) had a false negative study. Ranitidine, when administered either intravenously or orally for 24 h prior to the Meckel's scan, enhanced the sensitivity of this test to 87.5% in our patient cohort.
A new technique for primary reconstruction of a congenital anterior urethral diverticulum is described. This operation eliminates the obstruction caused by the distal lip of the diverticulum and at the same time strengthens the unsupported urethral wall using tissue from the walls of the diverticulum. It has been used very effectively in two boys.
Among pharyngo-esophageal diverticula the most frequent type is Zenker's diverticulum, which originates above the cricopharyngeal muscle and below the thyropharyngeal muscle. Laimer's diverticulum, located below the cricopharyngeal muscle, is a much rarer type. We report a case of a 54-year-old woman with a 3-year history of pharyngeal discomfort that was diagnosed as Laimer's diverticulum. To the best of our knowledge, this is only the third such reported case.
BACKGROUND: Two approaches can be used for treating Zenker's diverticulum operatively: external or endoscopic. METHODS: The records of 52 patients who underwent Zenker's diverticulum endoscopically were evaluated retrospectively. Twenty-two patients were treated with endoscopic scissors and 30 patients by carbon dioxide laser resection. The therapeutic concept of rigid endoscopic diverticulotomy was appraised with respect to the intraoperative and postoperative management for treatment and prevention of complications. RESULTS: Forty-four of 52 patients were free of symptoms and 8 patients (15.4%) had a recurrence, 4 of which were within 4 months. Except for 2 cases, the recurrences could be reoperated endoscopically. The complication rate was 13.5% with hemorrhage the most common complication (3 cases). Two cases required an external approach to control severe bleeding. CONCLUSIONS: The endoscopic approach for Zenker's diverticulum is safe and effective if the surgeon is prepared to handle extraordinary complications, such as severe hemorrhage, quickly and sufficiently.
Meckel's diverticulum is reported in only 1 or 2% of the population. In most cases, it is free of clinical symptoms. The diagnostic modalities are effective in only 60-70% of all cases. The diagnostic laparoscopy is a safe and effective method for patients suffering from unclear abdominal pain with the option of a definitive surgical therapy. We describe the case of a 10-year-old girl with recurrent abdominal pain caused by a chronic subileus due to a Meckel's diverticulum in combination with a fibrous cord from the base of diverticulum to the mesenterial root. Both were resected in a laparoscopic technique.
BACKGROUND: Zenker's diverticulum is associated with characteristic symptoms of progressive dysphagia and regurgitation. As most patients are elderly, the perioperative risk is usually high. We report our clinical experience with the transoral endoscopic staple-assisted method, including a thorough assessment of the symptomatic relief achieved by the procedure. METHODS: 46 consecutive patients (29 m, 17 f) with a median age of 61 years (range, 37-96 years) were treated between 1997 and 2002. The symptoms and their frequency were registered. The follow-up consisted of clinical and radiographic investigations. RESULTS: The median size of the diverticulum was 4 cm (range, 2-12 cm). Transoral treatment was successful in 39 patients; in 7 cases (15.2%) a switch to open surgery was required. The median operating time was 30 min (range, 10-150 min). Mortality rate was nil, while morbidity was 7.7%. The median duration of the postoperative hospital stay was 5 days (range, 1-65 days). After a median follow-up of 11 months (range, 1-40 months), 5 patients had been reoperated on endoscopically due to clinical recurrence. Clinical symptoms were significantly reduced (dysphagia of liquids p <or= 0.0001, dysphagia of solids p <or= 0.001, regurgitation p <or= 0.001). CONCLUSION: Our results confirm that minimal invasive treatment of Zenker's diverticulum is a safe method and provides significant symptomatic relief.
Endoscopic stapling diverticulostomy (ESD) using an endostapler is a modification of the standard endoscopic treatment of Zenker's diverticulum (ZD). It is characterized by complete myotomy of the upper esophageal sphincter, with division of the common wall between diverticulum and esophagus, followed by immediate simultaneous closure of the divided edges with the staples. ESD was performed on 21 patients with ZD between January 1996 and October 1997. The results were then evaluated. Operation time averaged 22 min. Wide opening of the diverticulum and excellent hemostasis were achieved. All of the patients but one, who died postoperatively of myocardial infarction, resumed oral intake without any evidence of cervical sepsis or mediastinitis. Complete relief of dysphagia was achieved in all 20 patients. Hospital stay averaged 4.7 days (range, 2-7 days). The patients were followed up after ESD for a median time period of 12 months. No relapses were recorded. ESD is an effective endoscopic treatment for ZD that entails a low risk of complications and requires only a short period of hospitalization.
Acquired ileal diverticulum is an uncommon condition and diagnosis is often difficult when bleeding occurs from this source. Here we describe two cases of ileal diverticulum with massive bleeding. Both patients presented with anal bleeding, but upper and lower gastrointestinal endoscopy did not reveal the source. Selective visceral angiography finally detected bleeding lesions in the terminal ileum. Surgical resection was performed in both patients, confirming that the bleeding arose from diverticula less than 1 cm in size. In patients with obscure gastrointestinal bleeding, an ileal diverticulum should be considered, and selective visceral angiography should be performed for precise diagnosis.
A perforation of Meckel's diverticulum by foreign bodies is an extremely rare cause of acute abdomen in adults. We herein present a case of a 30-year-old man who was admitted due to symptoms of right lower quadrant pain, anorexia, and vomiting. An exploratory laparotomy was done, and a perforated Meckel's diverticulum due to a chicken bone was found at exploration. A resection of a segment of ileum including the perforated diverticulum was performed, and the patient had an uncomplicated postoperative course.
An 18-year-old man was admitted to a local hospital with abdominal pain and bloody stool. Upper and lower gastrointestinal endoscopy failed to show any bleeding sites; however, an angiography of the superior mesenteric artery done on hospital day 4 showed an abnormal artery with an aneurysm, branching from the ileal artery. This artery was thought to be the vitellointestinal artery, a feeding artery of Meckel diverticulum. After embolization, he was transferred to our hospital, where we performed emergency laparotomy with partial resection of the ileum, including a bleeding Meckel diverticulum. Pathological examination revealed ectopic gastric mucosa and peptic ulceration, which we assumed was the origin of the bleeding. The patient had an uneventful postoperative course. Visceral artery aneurysms are rare but important vascular lesions because of their potential for fatal rupture. Although a minimally invasive procedure can be performed for a vitellointestinal artery aneurysm in patients with asymptomatic Meckel diverticulum, we treated our patient surgically because he presented with hemorrhagic shock and had been unresponsive to an H(2)-receptor antagonist.
We report herein a case of leiomyosarcoma of Meckel's diverticulum which presented as a rare manifestation of perforation. A previously healthy 63-year-old man was referred to the Tetsujinkai Eniwa hospital following the sudden development of acute abdominal pain. Abdominal computed tomography revealed a solid mass in the pelvic cavity, and an emergency operation was performed under a provisional diagnosis of peritonitis associated with a pelvic tumor. A perforated tumoral mass was found in Meckel's diverticulum. Segmental resection of the ileum, including the tumor-bearing diverticulum, was performed along with regional lymph node dissection. Histologic examination revealed the lesion to be leiomyosarcoma.
Epiphrenic diverticula are rare. The exact prevalence of this condition is unknown because asymptomatic patients are usually not discovered. Symptoms are more often the result of an esophageal motility disorder than the diverticulum itself and no correlation exists between the size of the diverticulum and the severity of symptoms. We present a patient suffering from dysphagia, chest pain, food retention and regurgitation because of an epiphrenic diverticulum. The current treatment of choice for symptomatic epiphrenic diverticula is diverticulectomy via a left thoracic approach. We performed a successful abdominal laparoscopic approach.
A 38-year-old female with a history of psychiatric illness presents with irritative urological symptoms and is diagnosed as having a large congenital vesical diverticulum (Hutch diverticulum). An overview of the aetiology, classification and complications of diverticula together with indications for and management of bladder diverticula is discussed. This is the first documented case of a very large symptomatic congenital diverticulum in a female presenting in the third decade of life and emphasizes the importance of ultrasound in irritative urological symptoms resistant to medication.
An unusual case of diverticulum of the left ventricle is presented. The most distinctive feature was the presence of a circumferential mid-ventricular contraction ring with histologic abnormalities similar to those described in patients with asymmetric septal hypertrophy. This abnormal ring of tissue obstructed emptying of the ventricular apex and isolated it from the rest of the ventricle. The obstructed apex assumed the appearance of a muscular diverticulum, and the residual portion of the ventricle was markedly diminished in volume. In addition, the abnormal mid-ventricular hypertrophy interfered with papillary muscle function, producing mitral valve prolapse and mitral regurgitation. The patient's age was equally unusual; she was 65 at the time of diagnosis, probably the oldest known patient with ventricular diverticulum. She was treated surgically by transapical myotomy and myectomy of the mid-ventricular contraction ring, in order to increase effective ventricular volume. The relationship of this entity to other types of ventricular deiverticula and aneurysms, and to hypertrophic cardiomyopathy, is discussed.
Meckel's diverticulum is the most common congenital abnormality of the small intestine, occurring in about 2 per cent of the population. Complications of a Meckel's diverticulum, including hemorrhage, inflammation, bowel obstruction, and neoplasms, occur in 15 to 33 per cent of cases and invariably demand operative treatment. When signs or symptoms arise from a Meckel's diverticulum, morbidity and mortality are high. Incidental Meckel's diverticulectomy should be performed at any age when the morbidity and mortality of the primary procedure will not be increased substantially.
An unusual complication of a Meckel's diverticulum, a strangulated Littre's femoral hernia, is presented. The incidence and complications of Meckel's diverticulum are discussed. It is emphasized that most complications occur before age 30. Thus in an adult an incidentally discovered Meckel's diverticulum should not be resected.
A 14-year-old girl underwent operation with the diagnosis of diverticulum of the superior vena cava. Microscopic findings revealed a diverticulum with venous architecture. This represents a rare case of a giant diverticulum of the superior vena cava.