Intramural diverticulosis of the esophagus associated with postoperative hiatal hernia, alkaline esophagitis, and esophageal stricture.
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Two infants with total colonic aganglionosis (TCA) extending into the distal part of the ileum are described. Considerable diagnostic delay occurred with the correct diagnosis established first at 3 and 8 months, respectively. Radiologic findings compatible with TCA such as prolonged barium retention, reflux into ileum following barium enema, and foreshortening of colon were not clearly evident initially. Both patients demonstrated multiple acquired colon diverticula which increased both in number and size during the period of observation. These diverticula are probably a late manifestation of the spastic state of the anganglionic colon. Thus demonstration of diverticula supplies a strong evidence of TCA in infants with intestinal obstruction.
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An adult female lesser flamingo (Phoeniconaias minor), caught in the African Rift Valley in 1991 and subsequently housed at the Baltimore Zoo, died of severe visceral gout in 1996. Necropsy revealed a white, moderately firm, nodular lesion, 1 cm in diameter, in the serosal wall of the small intestine. Although it was initially thought to be a tumor or focal granuloma, histologic examination revealed multiple cestodes deeply embedded at the base of the crypts between the intestinal villi, with their massive scolices (up to 3.4 mm in diameter) distending these spaces into multiple diverticulae. The mucosal epithelium surrounding the scolices was severely attenuated. Around the diverticulae, in the submucosa and muscularis, was a mild to moderate lymphocytic reaction and mild fibrosis. The proximity of multiple scolices and extensive invasion of host tissue suggested that the infection occupied a preexisting lesion. The cestodes were cyclophyllids but were distinct from any species previously reported from flamingos. Helminths should be included in differential diagnoses for gastrointestinal nodules in flamingos.
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