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PubMed1992

[Bleeding secondary duodenal diverticulum: a rare late complication following nephrolithotomy].

Secondary duodenal diverticula are due primarily to traction upon that section from some other cause such as ulcer, cholecystitis and so forth. It accounts for 1.6 to 20% of all duodenal diverticula. Numerous reports of gastrointestinal hemorrhage from duodenal diverticula have appeared in the literature. But massive UGI bleeding due to secondary duodenal diverticulum, caused by nephrolithotomy, was a rare late complication. Here we present a case of a 63-year-old male patient who underwent a right side nephrolithotomy 10 and 8 years previously, then developed massive UGI bleeding suddenly. Pre-operative UGI series and gastroscopy showed chronic duodenal ulcer and duodenal diverticulum at second section where much blood clot was noted. In time, a successful operation was performed. This complication of secondary duodenal diverticulum was rare, so consideration regarding management and surgical approach was discussed.

Diverticulum↗

PubMed1992

Bleeding from a Meckel's diverticulum after the use of ibuprofen.

A Meckel's diverticulum is an unusual site of gastrointestinal bleeding in adults. Bleeding often results from ulceration of ileal mucosa that lies adjacent to ectopic gastric mucosa. We report on a 27-yr-old man who bled from a Meckel's diverticulum after receiving oral ibuprofen, a nonsteroidal antiinflammatory drug. Examination of the resected diverticulum revealed fundal-type gastric mucosa with inflammation, submucosal hemorrhages, erosions and ulceration in the absence of Helicobacter pylori. The ileal mucosa was spared in this patient. These features suggest that oral ibuprofen caused damage to the ectopic gastric mucosa, precipitating significant hemorrhage. This is the first report in the English literature of such an occurrence.

Adult↗

PubMedDate not supplied

Laparoscopy for treating a small bowel obstruction due to a Meckel's diverticulum.

A Meckel's diverticulum is one cause of small bowel obstruction in the virgin abdomen. A 17-year-old female presented with a 24-hour history of lower abdominal pain and emesis. Radiological imaging studies revealed a high-grade partial small bowel obstruction. A diagnostic laparoscopy was performed revealing a bowel obstruction secondary to a Meckel's diverticulum. The diverticulum was resected using an endovascular GIA stapler. The patient was discharged on postoperative day 3, tolerating a regular diet. Laparoscopy is a useful diagnostic and therapeutic tool for a patient with a small bowel obstruction with an unclear etiology.

Adolescent↗

PubMedDate not supplied

Presentations of Meckel's diverticulum at Khyber Teaching Hospital Peshawar.

BACKGROUND: This study was conducted with an objective to observe various presentations of Meckel's Diverticulum in our setting and compare it with other national and international studies. METHODS: It was a retrospective analysis of hospital record carried out at the department of paediatric surgery Khyber Teaching Hospital, Peshawar. A total of 63 patients meeting the inclusion criteria were included in the study who had presented to our unit with signs and symptoms of Meckel's Diverticulum and who were diagnosed either by investigations or at surgery. All the patients were explored and resection and anastomosis performed. We did not do H. Pylori culture. Patients with bleeding per rectum were investigated by Meckel's scan. Analysis of the results was done by SPSS version 10. RESULTS: Majority of our patients presented with obstruction (82.5%) in contrast to the Western studies (around 40%) while only 4.7% presented with bleeding per rectum again in contrast to the Western countries (38.56%). CONCLUSION: There appears to be a geographical and/or racial difference in the presentation of Meckel's diverticulum.

Child↗

PubMed1992

[Transurethral incision and fulguration of the bladder diverticulum: radicality and clinical efficacy].

We performed transurethral incision and fulguration of the bladder diverticulum (TUIFBD) for 8 diverticula in 6 patients. In combination with TUIFBD, one patient received transurethral resection of the prostate and another one transurethral lithotripsy of bladder stones. TUIFBD has been easily performed without any operative complications. All 8 diverticula had shrunken from one to two months after the operation but only one diverticulum had disappeared. Symptoms related to the bladder diverticulum had disappeared postoperatively in all cases. In conclusion, TUIFBD can be easily and safely performed in combination with other transurethral surgical procedures. TUIFBD may be insufficient for radicality, but is clinically effective.

Aged↗

PubMed2004

[A case of chronic gastrointestinal bleeding from a Meckel's diverticulum detected by wireless capsule endoscopy].

Meckel's diverticulum is an embryonic derivative of the omphalomesenteric duct and the most commonly encountered congenital anomaly of the gastrointestinal tract. Its incidence records about 2%. Among them, only 5% are symptomatic with complications-bleeding, intestinal obstruction, inflammation, and perforation. In particular, bleeding is a common complication and has always been caused by an ulceration of the ileal mucosa adjacent to the acid-producing ectopic mucosa in a Meckel's diverticulum. Wireless capsule endoscopy is a new method enabling non-invasive diagnostic endoscopy of the entire small intestine. We experienced a case of Meckel's diverticulum detected by wireless capsule endoscopy in a 34 year-old man who presented with chronic obscure gastrointestinal bleeding.

Adult↗

PubMed2004

[Congenital male urethral diverticulum].

The male urethral diverticulum is a rare affection. The authors report one case of congenital urethral diverticulum. The diagnosis was approved by clinical examination and urethrocystography. Treatment was based by resection of the diverticulum and urethrography. On the basis of this case, the authors discuss the incidence, diagnosis and therapeutic aspects of this disease.

Diverticulum↗

PubMedDate not supplied

[Lithiasis of soft appearance within a calyceal diverticulum in the right kidney. Report of one case and therapeutic management].

OBJECTIVES: To report the case of a 28-year-old female patient carrying a lithiasis of soft appearance located within a calyceal diverticulum in the right kidney which presented clinically during pregnancy, and to comment on therapeutic management, as well as the outcome one year after conservative treatment. METHODS AND RESULTS: 28-year-old female patient with history of renal colic during pregnancy, who presents at our clinics in the postpartum period with a recurrent abdominal and lumbar pain. Kidney-ureter-bladder (KUB) x-ray and intravenous urography (IVP) detected a lithiasis of soft appearance within a calyceal diverticulum in the right kidney. Treatment was conservative with potassium citrate/citric acid and follow-up controls with urine culture (every 3 months) and ultrasounds (every 8 months). Currently she is asymptomatic but the lithiasis persists on KUB and urine culture is positive (Escherichia coli) and receives treatment with cefuroxime 250 mg every 12 hours for 6 days and nitrofurantoin 100 mg every night for three months. CONCLUSIONS: Most urinary stones located within calyceal diverticula have an asymptomatic course, treatment not being necessary. The most frequent clinical presentations of these stones are flank pain, urinary infection demonstrated by positive urine culture, and incidental finding. IVU is an effective method for diagnosis. ESWL is not an effective treatment for them, being percutaneous techniques the most suitable for a single-surgical procedure resolution of both lithiasis and pyelocalyceal diverticulum.

Adult↗

PubMed2004

Endometriosis presenting as a urethral diverticulum: a case report.

BACKGROUND: Pelvic pain is a common complaint among women of childbearing age. It has an extensive differential diagnosis that at times can make it difficult to determine its etiology. One must therefore rely on the characteristics of the physical examination, symptoms and imaging studies. However, in doing so, one should keep in mind that many diseases mimic one another. Physicians must be careful not to fall into the trap of simply assigning a specific disease to a given group of symptoms. CASE: A 35-year-old woman, gravida 2, para 0020, presented to a clinic complaining of left lower abdominal pain. She had a history of dyspareunia, dysmenorrhea, urinary frequency and numerous urinary tract infections. Previous laparoscopies had been negative for endometriosis. Physical examination demonstrated a 1.5-cm mass left of the midurethra. No pus was expressed through the urethra with cyst massage. Imaging showed a 1.1 x 1.1-cm lesion in the left posterolateral aspect of the urethra consistent with a urethral diverticulum. Uterine adenomyosis was also noted. Although clinical symptoms, physical examination and imaging suggested a urethral diverticulum, a vaginal endometriotic cyst was encountered at surgery. Pathologic evaluation of the surgically excised lesion revealed endometriosis, revealed endometriosis. CONCLUSION: In this case, clinical findings, location and imaging characteristics of a periurethral endometriotic lesion suggested a urethral diverticulum. Endometriosis should be considered in patients with a history of pelvic pain who present with urinary frequency and a periurethral lesion.

Adult↗

PubMed2004

Rare mesenteric location of Meckel's diverticulum, a forgotten entity: a case study aboard USS Kitty Hawk.

The traditional understanding of Meckel's diverticulum has always emphasized its antimesenteric location, ever since its original description in 1809. We report the finding of an acutely inflamed mass located on the mesenteric aspect of distal ileum, which was discovered during a celiotomy performed aboard a U.S. Navy aircraft carrier. Pathological features of this unusual mass, including focal submucosal abscess formation, proximity to the ileocecal valve, and heterotopic gastric tissue are all characteristic of inflammatory Meckel's diverticulum. The atypical intraoperative finding of a desmoplastic reaction associated with this lesion is discussed within the context of a pertinent differential diagnosis. In addition, both the pathological characteristics and the unusual location of this mass are the basis for a discussion that revisits a 50-year-old surgical controversy regarding Meckel's diverticulum.

Adult↗

PubMedDate not supplied

[Stromal tumor of Meckel's diverticulum--a rare source of gastrointestinal bleeding and a real diagnostic problem].

Although Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, complications in adults are rare, especially in the elderly. Lower gastrointestinal bleeding as a result of Meckel's diverticulum with ectopic gastric mucosa is unusual among the elderly. The case we report involved a 69 year old man with gastrointestinal hemorrhage found to be due a stromal tumor developed on Meckel's diverticulum. We considered our case interesting because of its rarity and of preoperative diagnosis difficulty.

Aged↗

PubMed2005

[How to identify the neck of a caliceal diverticulum in flexible ureterorenoscopy].

A caliceal diverticulum corresponds to a cavity communicating with the renal excretory tract via a neck. Surgical treatment is required when the caliceal diverticulum is symptomatic with repercussions on the patient's quality of life. A retrograde approach via holmium:YAG laser ureterorenoscopy has been recently used to treat the stone and externalize the caliceal diverticulum into the pyelocaliceal cavities. The problem raised by this approach is identification of the diverticular neck. The objective of this technical note is to describe a technique to facilitate identification of the diverticular neck.

Diverticulum↗

PubMed2005

[Surgical management of incidental Meckel's diverticulum: the necessity to obtain the informed consent].

Surgical approach to the incidentally found Meckel's diverticulum (MD) is still source of debate: some support the systematic search and the surgical resection, others suggest to leave in situ the asymptomatic diverticulum. A wide literature review and some claims for malpractice referred to resection of diverticular formations (2 cases are described herein) allow us to deem that the removal of an asymptomatic MD may be an excess of surgical indication regarding an entity that cannot be defined as pathological for itself; anyway, the informed consent must be obtained before the incidental resection. The consent to the removal of MD must always be requested for laparotomies in which the surgeon forecasts the possibility to remove a diverticulum eventually found. Finally, an easy informed consent form about an incidentally found MD to be submitted to the patient is proposed.

Child↗

PubMedDate not supplied

[Laparoscopic management of oesophageal epiphrenic diverticulum: a case report].

Epiphrenic diverticuli are rare pulsion "pseudodiverticuli" of the distal oesophagus that are commonly associated with oesophageal motility disorders. Surgical treatment is usually reserved for patients with symptoms. Traditionally, patients are treated with diverticulectomy, myotomy and fundoplication via a left thoracotomy. The aim of this study was to describe the laparoscopic technique and review the international literature on this minimally invasive approach. We report the case of a 66-year-old woman with a 1-year history of retrosternal pain, regurgitation and weight loss caused by an oesophageal epiphrenic diverticulum. The patient underwent barium oesophagography and oesophagogastroduodenoscopy. The oesophageal diverticulum measured 5 cm. We treated the condition with a laparoscopic oesophageal diverticulectomy, Heller myotomy and Dor fundoplication with intraoperative endoscopy. The operative time was 210 minutes. The postoperative course was complicated by a suspected leakage from the staple line, which was not subsequently confirmed. The patient is now totally asymptomatic after 3 months. Laparoscopy offers good access to the distal oesophagus and the inferior mediastinum. Resection of the diverticulum, treatment of the motor disorder and prevention of postoperative reflux can be obtained with this approach. It should be considered as an alternative to the traditional transthoracic approach and may eventually become the standard technique.

Aged↗

PubMed2005

Upper gastrointestinal bleeding caused by a "hypophrenic" diverticulum of the distal esophagus.

Distal esophageal diverticula are uncommon acquired anomalies of the distal thoracic esophagus. We report a case of an elderly man presenting with a history of upper gastrointestinal bleeding secondary to a distal esophageal diverticulum arising from the intra-abdominal portion of the esophagus. To our knowledge, this is the first report of upper gastrointestinal bleeding from a subdiaphragmatic esophageal diverticulum. We propose the term "hypophrenic diverticulum of the esophagus" for this disease entity, and we would like to bring it to the attention of readers of The American Surgeon.

Aged↗

PubMedDate not supplied

Laparoscopic resection of a gastric diverticulum: a case report.

A 30-year-old woman presented with halitosis, sour taste, bloating, and right-sided abdominal pain of 3-months' duration. An upper gastrointestinal series revealed a diverticulum in the posterior cardia of the stomach. The patient underwent a laparoscopic resection of the diverticulum. Postoperatively, the patient did well; at a 28-month follow-up, no further symptoms were reported. Laparoscopic removal of a diverticulum produced an excellent outcome.

Adult↗

PubMed2005

Vesicocutaneous fistula arising from a bladder diverticulum.

A 55-year-old man presented with intermittent episodes of urinary leak through the left groin following an abscess drainage at that site at the age of 5 years. Since then he had been suffering from recurrent urinary tract infections and urinary leak, which used to be treated symptomatically. Intravenous urogram (IVU), voiding cystourethrogram (VCU), and cystoscopy done in our institution revealed a bladder diverticulum with a stone in situ, which was communicating with the fistulous opening located in the left groin. Diverticulectomy and excision of the fistulous tract cured the patient. A long-standing fistula arising from a bladder diverticulum at relatively distant site is of extreme rarity. Vesicocutaneous fistula from an iatrogenic injury to vesical diverticulum resulting from a groin surgery has not been reported so far.

Cutaneous Fistula↗

PubMedDate not supplied

A rare case of massive gastrointestinal hemorrhage caused by Meckel's diverticulum in a 53-year-old man.

A 53-year-old man with a history of lung cancer mestastic to the brain and pelvis presented with hypotension and massive GI bleeding. He had no past history of gastrointestinal disease or bleeding. The patient was found to have an unusual focal source of bleeding--a large ulcerated Meckel's diverticulum with acute hemorrhage. Meckel's diverticulum is the etiology of most gastrointestinal bleeding episodes in the pediatric population; however, bleeding from a Meckel's diverticulum in an adult is rare and only three other cases have been reported. We present this case report and a literature review.

Gastric Mucosa↗