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PubMed1994

Laparoscopic diagnosis and excision of Meckel's diverticulum.

Meckel's diverticulum is one of the primary concerns in the differential diagnosis of the pediatric patient with massive, acute gastrointestinal bleeding, intussusception, or abdominal pain of uncertain cause. The hospital course of two children with Meckel's diverticulum, successfully treated by laparoscopic excision, is presented, along with details of the operative procedure. Both patients recovered from the procedure without incident and were discharged at 24 and 48 hours after surgery. The authors believe a laparoscopic approach is safe and effective in the diagnosis and treatment of Meckel's diverticulum.

Adolescent↗
PubMed1984

Congenital diverticulum of male urethra.

Congenital diverticulum of the male urethra is an uncommon condition. Urinary tract infection, urethral obstruction, and disturbances in micturition are the most common symptoms. Six cases of congenital diverticulum of the male urethra were studied with regard to diagnosis and treatment. Four patients underwent endoscopic treatment of the diverticulum. The procedure is simple and rapid, with low incidence of complications and high rates of success.

Adolescent↗
PubMed1988

Percutaneous balloon dilatation in treatment of infected pyelocaliceal diverticulum.

Abscess formation is a known complication of pyelocaliceal diverticulum. Although successful management of stones complicating pyelocaliceal diverticulum has been described utilizing percutaneous techniques, this is the first report to our knowledge of a percutaneous technique that simultaneously manages an acute abscess and provides for ablation of the diverticular cavity thus preventing future recurrences. The method involves placement of single or multiple stents spanning the diverticulum and the collecting system proper following percutaneous dilatation of the narrow isthmus that usually provides the communication with the main collecting system. The procedure offers an economical and tissue-sparing approach, which obviates the need for major abdominal or retroperitoneal operation.

Abscess↗
PubMed1993

Ectopic ureter presenting in midline urethral diverticulum.

A rare case of an ectopic ureter terminating in a urethral diverticulum is presented. While numerous cases of extravesical ectopic ureters draining directly into the urethra or uterovaginal canal have been reported, the termination of a ureter as a diverticular sac is extremely unusual. Moreover, only rarely has a urethral diverticulum been documented to arise congenitally due to any cause. The history and management of this new case are detailed, and the general subjects of ectopic ureter and urethral diverticulum are discussed with particular reference to etiology and continence.

Adult↗
PubMed1990

Stapler resection of Meckel's diverticulum during gynecologic cancer surgery.

Stapler resection of Meckel's diverticulum was performed on 16 patients with known or presumed gynecologic malignancy at the time of extended abdominal surgery. All diverticulectomies were done quickly and without morbidity. Heterotropic gastric epithelium was found in one diverticulum, and one other patient with stage III ovarian adenocarcinoma had metastases to the serosa of her Meckel's diverticulum.

Adult↗
PubMedDate not supplied

Intussuscepted Meckel diverticulum: radiologic-pathologic correlation.

Nine cases of Meckel diverticulum presenting with intussusception were reviewed and correlated clinically, radiologically and pathologically. The appearance of intussuscepted Meckel diverticulum by small bowel series is not specific. However, by CT, a central fat density surrounded by a thick collar of soft tissue was noted in one case correlating well with the gross pathologic appearance. The pathologic material in all our cases suggests that this CT appearance is characteristic of an inverted Meckel diverticulum.

Barium Sulfate↗
PubMedDate not supplied

Inverted Meckel's diverticulum.

Although Meckel's diverticulum is a relatively common anomaly, inverted Meckel's diverticulum has been reported rarely. We describe a 59-year-old woman with inverted Meckel's diverticulum located at the distal ileum simulating a benign tumor. Computed tomography showed a small mass with a central area of low fat density, and appearance not described previously.

Adipose Tissue↗
PubMed2006

Diagnosis and outcome in congenital ventricular diverticulum and aneurysm.

OBJECTIVE: True congenital ventricular diverticulum and aneurysm in children are very uncommon. We report our experience to clarify the diagnosis and outcome of these little-known entities. METHODS: Twenty-two patients with congenital ventricular outpouchings were identified in our database from 1973 to 2004. Morphologic characteristics (localization, connection to a ventricle, contractility), histologic findings, and cardiac and/or extracardiac abnormalities were analyzed in all 22 patients. Cardiovascular events and clinical courses were reviewed. RESULTS: Congenital ventricular diverticula (n = 16) were characterized by synchronal contractility and three myocardial layers on histologic examination. Two categories of congenital ventricular diverticulum could be identified with regard to their localization: apical and nonapical. Apical diverticula (n = 8) were always associated with midline thoracoabdominal defects and other heart malformations. Nonapical diverticula (n = 8) were always isolated defects. Congenital ventricular aneurysms (n = 6) were characterized by akinesis with paradoxical systolic motion, wide connection to the ventricle, fibrosis on histologic examination that appeared with high signal on T2 weighted magnetic resonance imaging, and absence of other heart or midline thoracoabdominal defects. The outcome was different in these two types of outpouchings: congential ventricular aneurysms were associated with adverse outcomes whereas the prognosis for congenital ventricular diverticula was good. CONCLUSION: Congenital ventricular diverticulum and aneurysm are two distinct entities, with different histologic and morphologic characteristics and outcomes. Assessment of these differential characteristics is of importance for prenatal counseling.

Diagnosis, Differential↗
PubMed2007

Female urethral diverticulum: 26-year followup of a large series.

PURPOSE: Female urethral diverticulum is an acquired condition associated with distressing and chronic symptoms. Surgery sometimes represents a technical challenge and various complications may follow treatment. We present the results of a retrospective analysis in a large personal series operated on during a 26-year period. MATERIALS AND METHODS: A total of 68 women underwent surgery. The medical records of all women were reviewed and a followup telephone interview was conducted by an investigator not involved in the care of the patients. There were 64 women available for the interview who were questioned using a standard questionnaire. RESULTS: In the majority of patients the postoperative course was uneventful and no complications were encountered. However, a relative stricture of the urethra developed in 1 woman and fistulas developed in 4. In 1 patient the fistula was small and distal, and was left without further surgery. Although diverticulum recurred in 11 patients and urinary incontinence of varying degrees was rather common, as was dyspareunia, 59 patients (92%) would still recommend surgery to a friend having symptoms of the severity they had experienced themselves. CONCLUSIONS: Residual symptoms were surprisingly common in the long term. However, most of them were tolerable and it is noteworthy that almost all patients found the operation quite worthwhile when looking back to their preoperative situation. It was evident that repeated surgery frequently resulted in various sequela. The first operation is the golden opportunity for long-term success and a lesson to be learned is that operations for female urethral diverticulum would preferably be centralized to a limited number of surgeons.

Adult↗
PubMed2003

Association between Zenker diverticulum and gastroesophageal reflux disease: development of a working hypothesis.

A cause-and-effect relation between gastroesophageal reflux disease and Zenker diverticulum remains unclear. Convincing evidence exists demonstrating that patients with Zenker diverticula have increased resting tone of the cricopharyngeus muscle, and that this may be an important initiating factor for the development of Zenker diverticula. Yet some patients with cricopharyngeus hypertonicity never develop Zenker diverticulum. In this context, we hypothesize that acid-induced esophageal shortening may be an important cofactor. We suggest that acid reflux induces longitudinal esophageal shortening, which in turn increases the risk for the development of herniation between 2 spatially related structures, the pharyngeal constrictors and cricopharyngeus muscles, leading to the development of Zenker diverticulum. This hypothesis awaits clinical verification.

Gastroesophageal Reflux↗
PubMed2003

Carbon dioxide laser diverticulostomy: a new treatment for Zenker diverticulum.

In the United States, the traditional treatment for hypopharyngeal (Zenker) diverticulum has been single-stage transcutaneous diverticulectomy. Complications following this procedure include mediastinitis, vocal cord paralysis, esophageal stenosis, fistula, and recurrent or persistent diverticula. The development of endoscopic equipment has led to a new era of surgery for this condition. Magnification of anatomic landmarks allows for better precision during surgery and reduces both surgical procedure time and postoperative complications. Additional techniques, such as diathermy, bipolar coagulation, stapler, and laser surgery, all of which decrease intraoperative bleeding, lend further support to the procedure. In several randomized controlled clinical trials, endoscopic laser treatment of diverticulum has demonstrated the best results in terms of decreased morbidity and fewer complications. Thus, laser approaches for treating Zenker diverticulum deserve consideration.

Carbon Dioxide↗
PubMed2003

[Plea in favour of external cervicotomy approach of Zenker's diverticulum: 73 cases reported].

INTRODUCTION: Zenker's diverticulum can be treated surgically or endoscopically. The aim of this study was to assess results of surgical approach with cervicotomy and diverticulectomy. PATIENTS AND METHODS: We retrospectively studied the data of 73 patients (50 men and 23 women; mean age, 69 ans; extrêmes: 43-98) consecutively operated on for a Zenker's diverticulum between 1987 and 2000. Surgical procedure included diverticulectomy associated with a large myotomy and oesophageal calibration. Both early and long-term results were compared with those of published series of patients treated by stapled esophagodiverticulostomy. RESULTS: Clinical manifestations were: dysphagia (97%), regurgitations (76%), aspirations (45%), weight loss (28%), lung infection (21%), or halitosis (3%). No patient died postoperatively. The early morbidity rate was 4% (3 patients). The mean delay for return of oral feeding and the mean length of hospital stay were respectively 6 and 8 days. At follow-up (mean follow-up, 6 years; extremes: 3 months-13 years), 72 patients (99%) were satisfied and 1 patient felt partially improved. Analysis of published results of series of endoscopic treatment revealed shorter lengths of hospital stay but less favourable long-term results. CONCLUSIONS: Early morbidity of surgical treatment of Zenker's diverticulum is low. Long term functional results could be better after surgical diverticulectomy with myotomy than after endoscopic stapled esophagodiverticulostomy.

Adult↗
PubMed1998

Zenker's diverticulum in the elderly: is operation justified?

BACKGROUND: Surgical correction of symptomatic Zenker's diverticulum is effective; however, elderly symptomatic patients may be denied surgical intervention because of perceived increased risks. METHODS: To address this concern, we reviewed 75 patients (46 men and 29 women) found to have this condition during the past two decades. RESULTS: Median age was 79 years (range, 75 to 91 years). Preoperative symptoms included dysphagia in 69 patients (92%), regurgitation in 61 (81%), pneumonia in 9 (12%), halitosis in 3 (4%), and weight loss in 1 (1%). Gastroesophageal reflux symptoms were noted in 27 patients (36%). Diagnosis was made by barium swallow in 63 patients, esophagoscopy in 5, and a combination of both in 7. Surgical procedures included both diverticulectomy and myotomy in 57 patients (76%), myotomy alone in 9 (12%), diverticulopexy and myotomy in 5 (7%), and diverticulectomy alone in 4 (5%). There was no in-hospital mortality. Complications occurred in 8 patients (11%) and included esophagocutaneous fistula in 4, pneumonia and urinary tract infection in 1, and wound infection, myocardial infarction, and persistent diverticulum in 1 each. Follow-up was available in 72 patients (96%) and ranged from 8 days to 17 years (median, 3.3 years). At follow-up, 64 patients (88%) were asymptomatic and 4 (6%) were improved with minimal symptoms. The remaining 4 patients (6%) have had varying degrees of dysphagia and all have been treated with periodic esophageal dilations. CONCLUSIONS: Operation for symptomatic Zenker's diverticulum in the elderly is safe and effective and will result in resolution of symptoms and improved quality of life in most patients.

Aged↗
PubMed2005

[Endoscopic treatment of Zenker's diverticulum].

INTRODUCTION: We report our experience in the endoscopic (flexible) treatment of Zenker's diverticulum. PATIENTS AND METHOD: Three patients with medium-sized Zenker's diverticula were treated by endoscopic cricopharyngeal myotomy with a modified needle-knife sphincterotome through a therapeutic gastroscope. The procedure was performed in the digestive endoscopy unit under conscious sedation without anesthetic support. RESULT: Endoscopic cricopharyngeal myotomy was completed in a single session without immediate or late complications. In all three patients dysphagia disappeared and all were discharged at 48 hours with a solid diet. After 12, 18 and 17 months of follow-up there has been no recurrence of dysphagia or other symptoms attributable to Zenker's diverticulum. CONCLUSION: Flexible endoscopic cricopharyngeal myotomy is a simple, effective and safe treatment of Zenker's diverticulum that avoids the need for open cervical surgery and general anesthesia.

Aged↗
PubMed2006

[Traumatic perforation of a duodenal diverticulum].

Duodenal diverticulum is a frequent abnormality that is usually diagnosed incidentally. Clinical manifestations usually mimic highly varied entities. Among the complications of duodenal diverticulum, perforation is fairly rare and rupture due to blunt trauma is even rarer. We describe the case of a male patient who presented a perforated duodenal diverticulum after an accidental fall.

Abdominal Injuries↗
PubMed1987

The diagnosis of Meckel's diverticulum: a continuing challenge.

During a 10 year period 49 patients were operated upon in Oxford for Meckel's diverticulum. Radiological imaging of the small intestine with radionuclide scintigraphy, small bowel barium enema or angiography was performed in 11 patients. Radionuclide scintigraphy was positive in one out of six patients investigated. The small bowel barium enema detected an abnormality in seven out of eight patients examined and identified the diverticulum in six. Angiography was performed in three patients and active bleeding was demonstrated in two. Our experience would indicate that the small bowel enema is the method of choice for the investigation of suspected Meckel's diverticulum. Patients with acute bleeding should, however, be investigated with angiography.

Adolescent↗
PubMed1998

Gastric diverticulum: an uncommon cause of abdominal pain in a 12 year old.

A 12-year-old girl presented with long-lasting intractable abdominal pain associated with a gastric diverticulum. The clinicopathologic features of this rare entity are discussed with emphasis on pathogenesis, diagnosis, and treatment. The authors emphasize that congenital diverticulum of the stomach should be considered in the differential diagnosis of abdominal pain in childhood. Surgical treatment consisting of simple excision of the diverticulum is warranted in cases presenting with long-lasting symptoms after failure of medical treatment.

Abdominal Pain↗