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PubMed1999

[Nephrogenic adenoma arising from an urethral diverticulum in a female. Report of a case and review of the literature].

Nephrogenic adenoma is a benign epithelial tumour localised at the level of the urothelium and caused by metaplasia of the urothelium following prolonged aggressive stimulation over time, for example trauma or chronic urinary infection. Even a diverticulum, in whatever site it is localised, is subject to an increased risk of neoplastic transformation of the urothelium. It above all affects male subjects, with a male/female ratio of 3:1 over the age of 20, which is inverted in younger subjects. The most frequently affected site is the vescical trigonum in 72% of cases, followed by the pelvic tract of the ureter (19%) and urethra. The majority of patients is asymptomatic or reports aspecific symptoms: the most frequent picture is macroscopic hematuria, owing to the rich vascularisation of the tumour. This is followed by irritative type signs such as pollakiuria, strangury, posturination dripping and sometimes painful tenesmus. Differential diagnosis is necessary for pale cell adenocarcinoma, parauretral cysts and Gartner duct's cysts which may be associated with urethral diverticulum, localised on the bottom, and rarely symptomatic. Diagnosis is based on retrograde urethrography, cystography and endoscopic tests, with biopsy if necessary. NMR provides further details regarding the site, localisation and benign or malignant nature of the lesion. Treatment is surgical: endoscopic (transurethral) if the dimension are limited, or traditional using a suprapubic or transvaginal route if it is associated with diverticulum. Prognosis is discrete and depends on the timeliness with which the factors predisposing metaplasia are eliminated.

Adenoma↗
PubMed1999

[Leiomyosarcoma of Meckel's diverticulum--a rare cause of acute hemorrhage in the lower part of the digestive system].

Meckel's diverticulum is a rare cause of haemorrhage into digestive tract in adults. A tumour arising in the diverticulum is also a rare cause of bleeding. Leiomyosarcomas represent 10-20% of malignant tumours in the small bowel and 1% of those located in the large bowel. These tumours have non-specific symptoms depending on their size, location and histology. Intestinal leiomyosarcomas may be the cause of surgical emergencies. We describe the case of an adult male with acute painless intestinal bleeding the cause of which was a leiomyosarcoma arising in Meckel's diverticulum. It was diagnosed during an acute operation. The main cause of the surgical emergency was an extremely rare complication of gastrointestinal leiomyosarcoma--intestinal bleeding.

Gastrointestinal Hemorrhage↗
PubMed1999

[Surgical treatment of internal duodenal diverticulum. Report of 2 clinical cases].

Internal duodenal diverticulum is a rare disease. Nowadays, less than 100 cases are reported in Western literature. Even if it is a pathology of malformative origin, the first clinical manifestations occur quite always during the III decade. Main symptom is a violent, suddenly arisen, abdominal colic, often associated with meals and with spontaneous remission. Frequency of accesses is variable in time; in most serious cases, colics are so close to cause a considerable reduction of nutrition. Among diagnostical means, very useful are Rx enema (that offers pathognomonical images) and endoscopy, by which the formation can be visualized directly and its connection with papilla can be delineated. In some rare cases, differential diagnosis has to be made with cystic dilatations of bile duct, and particularly with type III according to Alonso-Lej classification or choledochocele. When such a distinction is not possible, differential diagnosis will be made on the basis of histological examination of the type of mucosa present in the internal aspect of the diverticulum. Therapy of symptomatic forms is surgery. The technique of choice is transduodenal diverticulectomy. Cannulation of bile duct is a useful means to found the papilla during intervention, to protect duodenal suture in the postoperative period and to control it radiologically. Two cases of internal duodenal diverticulum operated on in the last 2 years are described and diagnostical and therapeutical items are discussed.

Adult↗
PubMed2000

[Leiomyosarcoma of Meckel's diverticulum in cystic form].

BACKGROUND: Leiomyosarcoma is an uncommon small bowel tumor. About 60 cases of a Meckel's diverticulum localization have been reported. We present a very rare form of leiomyosarcoma arising in a Meckel's diverticulum, mimicking a very large abdominal cyst. CASE REPORT: Abdominal ultrasound evidenced a voluminous cystic mass in the abdomen of a 37-year-old man consulting for abdominal discomfort. Computed tomography visualized a tissular component with contrast uptake. Laparotomy was performed with resection of a 4 liter cyst on the Meckel's diverticulum. Histology reported leiomyosarcoma. DISCUSSION: Leiomyosarcoma of the small bowel mainly develops in an extraluminal localization. Necrotic remodeling explains the cyst formation. Computed tomography with contrast injection can be most helpful for diagnosis. Surgery provides the only possible cure in still localized forms. Other treatments have failed to demonstrate any benefit. Prognosis is mainly related to the histological grading according to the mitotic index.

Adult↗
PubMed1998

[Meckel's diverticulum and its complications in children].

Seventy-two cases of Meckel's diverticulum were treated surgically in recent four years. There were 61 boys and 11 girls with a mean age of 5.2 years. Of the 65 symptomatic patients, 31(43%) had rectal bleeding, 16(23%) suffered from bowel obstruction and 17(24%) peritonitis. Patients with diverticulitis(8 cases) had acute abdominal pain in the periumbilical region or in the right lower quadrant compatible with appendicitis. Ectopic mucosa was found in 47 cases(65.3%). Gastric(36 cases) and pancreatic(11 cases) were the most common ectopic tissues. A nuclear medicine Meckel scan was positive in 26 of 31 patients(84%). It is emphasized that 99mmTcO4- scintiphoto is more specific in diagnosis of the Meckel's diverticulum. The best choice of the surgery is resection of the diverticulum and end-to-end intestinal anastomosis.

Adolescent↗
PubMed1975

Demonstration of bleeding from Meckel's diverticulum by means of selective arteriography of the superior mesenteric artery.

The diagnosis of a bleeding Meckel's diverticulum was made in a young man who presented several episodes of rectal bleeding over a period of 3 years. Attempted diagnosis by barium studies did not reveal the diverticulum. Angiography of the superior mesenteric artery revealed a wide and tortuous ileal branch -and at its distal end extravasation of contrast medium, within the walls of the diverticulum. It is suggested that in case of major bleeding from the lower GI tract, arteriography should be performed before other contrast medium studies.

Adult↗
PubMed1999

Ureter diverticulum of transplanted kidney. Case report.

OBJECTIVES: Authors present a case of successful surgical treatment of a ureter diverticulum observed 3 months after kidney transplantation. METHODS: The fluid collection was detected by ultrasound. Percutaneous drainage was performed, after that the excretion of 4 litres of fluid was observed during 12 hours. This finding clearly indicated the connection with the urinary system. This fact was proved and precisely localised by contrast filling of the lesion under fluoroscopic control. RESULTS: Resection of the ureter diverticulum was performed, and the patient recovered fully, there was no change observed in the graft function during the whole procedure. CONCLUSION: The ureter diverticulum is a rare complication after kidney transplantation: the present case is the only one observed among more then 600 kidney transplantations performed during 20 years in our centre.

Adult↗
PubMed2000

Gastric adenocarcinoma of Meckel's diverticulum as a cause of colonic obstruction.

A 45-year-old-female patient with no prior surgical history presented with bowel obstruction. At laparotomy, a bulky tumor arising from the ileum, which completely obstructed the sigmoid colon, was found. A left hemicolectomy followed by a transverse colostomy and a Hartman's pouch were performed. Pathological examination of the specimen revealed gastric adenocarcinoma arising from a Meckel's diverticulum in the ileum. Malignant transformation from a Meckel's diverticulum is an uncommon occurrence. This case illustrates that successful management of a symptomatic Meckel's diverticulum, even with malignant transformation, can be achieved by surgical resection.

Adenocarcinoma↗
PubMed2000

Carcinoid tumor in Meckel's diverticulum: laparoscopic treatment and review of the literature.

Meckel's diverticulum is a common anomaly of the small intestine that occurs in approximately 2% of the population, often found incidentally at the time of abdominal exploration. Carcinoid tumors in a Meckel's diverticulum have been reported in only 111 cases. The author describes a patient who presented for elective cholecystectomy and who during laparoscopy was found to have an abnormal-appearing ileal diverticulum. The resected specimen contained a carcinoid tumor. The decision-making process in treating these patients is reviewed along with a discussion of the laparoscopic treatment of intra-abdominal pathologic conditions found incidentally at the time of elective surgery.

Carcinoid Tumor↗
PubMedDate not supplied

[Ileal occlusion caused by enterolith migrated from Meckel's diverticulum].

The authors present a case report of an intestinal obstruction due to a relatively big coprolite migrated from a large Meckel's diverticulum to the distal Ileum. The patients apparently healthy and a vegetarian, complained on admission of the absence of emission of faeces and gas since four days before with noticeable abdominal distension. In the physical examination he presented intestinal meteorism, a hard abdomen, painful on deep palpation in the median quadrants, especially in the epigastric and mesogastric ones. The abdominal X-RAY in the standing position confirms: an occlusive state with numerous liquid levels in the Ileum. Because of a worsening of the symptomatology and the appearance of generalized comprimission, two days later an exploratory laparotomy was performed. The intervention showed the presence of a Meckel's diverticulum with approximately 10 cm in length, with an ample neck, the distal Ileum for approximately 15 cm in dilation returned rapidly to a normal calibre, after a pastous endoluminal formation borne in the Meckel's diverticulum (Meckel resection presented actually a large niche at the fundus level with a eroded wall) and migrated in the distal Ileum where it could cause the obstruction. In the present case it is probably useful to perform a preoperative CT scan in order to get a precise etiology and perform an ascending Colonscopy, so avoiding a surgical procedure. According to the authors a CT scan is indicated in all cases of intestinal occlusion of unknown case, in order to have a more precise definition of the physiopathology of the occlusion.

Calculi↗
PubMedDate not supplied

Superselective embolization for bleeding from duodenal diverticulum: a case report.

Duodenal diverticulum is a well-known pathological entity. The majority of patients with this condition are asymptomatic. Although hemorrhage has been described, it is an infrequent complication. We report a patient who presented with massive upper gastrointestinal bleeding with hypovolemic shock, originating from a duodenal diverticulum. The diagnosis was made by emergency angiography. Superselective arterial embolization was performed with a successful outcome. To the best of our knowledge, superselective embolization for hemorrhage originating from a duodenal diverticulum has not previously been described in the literature.

Angiography↗
PubMed2000

[Dysphagia caused by Zenker's diverticulum after total laryngectomy].

Zenker's diverticulum is a mucosal lined outpouching of pharynx through Lainert's space that causes dysphagia of the upper digestive tract. Multiples theories try to explain the acquired etiology of this entity, attributing its origin to a disfunction of pharynx-esophageal sphincter. A case of total larynguectomy with hypopharyngeal diverticulum and progressive dysphagia to solid food is presented. We analyze the etiopathogenic mechanisms and the definitive characteristics of this entity. We review mundial literature, being exceptional the fact of finding clinical manifestations in diverticulum of larynguectomized patients.

Deglutition Disorders↗
PubMedDate not supplied

Internal hernia caused by Meckel diverticulum in an infant: report of one case.

Intestinal obstruction caused by internal hernia due to Meckel diverticulum is a rare disease. The condition is seldom diagnosed preoperatively. In this paper, we present a 10-month-old boy who suffered from abdominal pain, persistent vomiting, and mild fever for 2 days. Abdominal sonography, plain abdomen X-ray, and computed tomography merely showed mechanical ileus and partial malrotation. However, exploratory laparotomy revealed a Meckel diverticulum through which the small bowel had herniated. We introduce the Meckel diverticulum and internal hernia and discuss intestinal obstructions.

Hernia↗
PubMedDate not supplied

Recurrent bleeding from a duodenal diverticulum 8 years after endoscopic treatment: case report and review of the literature.

A 70-year-old woman presented with a 2-day history of tarry stool. She had a history of hemorrhage from a duodenal diverticulum of the 2nd portion 8 years previously that had been managed successfully by endoscopic hemostasis. Initial gastrointestinal endoscopy revealed ulceration of the diverticulum with no active bleeding; nevertheless the ulceration was presumed to be the source of the tarry stool. Despite medical treatment, bleeding started again, but endoscopic ethanol injection achieved hemostasis. When bleeding started yet again 8 days after the endoscopic therapy, the patient underwent diverticulectomy. Although duodenal diverticula are frequently found in the adult gastrointestinal tract, they rarely show hemorrhage. Recently, there has been controversy about whether bleeding diverticula should be managed surgically or endoscopically. We describe for the first time a rare case of recurrent hemorrhage of a duodenal diverticulum after an 8-year interval; the case was treated by surgical diverticulectomy as a definitive therapy for the recurrent bleeding ulcer. We also present a review of the literature.

Aged↗
PubMed2002

[Epidermoid carcinoma on Zenker's diverticulum].

Carcinoma is a rare but recognized complication of pharyngoesophageal diverticulum. We report the case of a 49-year-old man operated for a Zenker's diverticulum with an epidermoid carcinoma arising in the diverticulum. Since carcinoma is an uncommon complication of this pathology, we review the literature and discuss the therapeutic options.

Carcinoma, Squamous Cell↗
PubMed2002

Diverticulum of the right ventricle associated with pulmonary stenosis, rhabdomyoma and Wolff-Parkinson-White syndrome.

Congenital cardiac diverticulum is a rare anomaly that may present as an isolated lesion or in association with other malformations. Diverticulum of the left ventricle is more common than that of the right ventricle. We report a case of cardiac diverticulum over the right ventricular outflow tract and associated pulmonary stenosis, right atrial rhabdomyoma, and Wolff-Parkinson-White syndrome in a 9-month-old boy. The delta wave disappeared after removal of the atrial rhabdomyoma.

Diverticulum↗
PubMed1976

Specificity of 99mTc-pertechnetate in scintigraphic diagnosis of Meckel's diverticulum: review of 100 cases.

Numerous reports in the recent literature have questioned the value of abdominal scanning with pertechnetate in the diagnosis of Meckel's diverticulum. In an attempt to evaluate further the specificity of pertechnetate in this condition, the clinical data and scintigrams of 100 patients with suspected Meckel's diverticulum were reviewed. The scintigram correctly identified Meckel's diverticulum before operation in seven of eight patients. One false-negative study occurred in 33 patients who underwent laparotomy. Conditions suggested as possible causes of false-positive studies (hydronephrosis, arteriovenous malformations, and intussusception) were found to give negative scans.

Adolescent↗
PubMed2003

A loop formation of Meckel's diverticulum: a case with obstruction of the ileum.

An adult case of obstruction of the ileum caused by a loop formation of Meckel's diverticulum is described. The patient, having severe abdominal pain and vomiting, was diagnosed as having ileus. A roentgenogram with a contrast medium showed severe obstruction at the mid part of the ileum. From findings of elective laparotomy, adhesion between the inflammatory end of Meckel's diverticulum and the corresponding mesenterium had formed a loop, which had clasped the distal part of ileum. We here warn that Meckel's diverticulum forming a loop is a cause of obstruction of the ileum in adults.

Abdominal Pain↗