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PubMed1997

[A case of adenocarcinoma arising in the vesical diverticulum].

A 70-year-old woman presented at our hospital with the chief complaint of gross hematuria and pain on urination. Cystoscopy revealed a broad-based tumor covered with mucus on the right wall of the bladder and therefore a transurethral resection was performed. At surgery the tumor was found to arise from the diverticulum and could not be resected because of the risk of perforation. A histopathological examination disclosed adenocarcinoma including a small region of signet ring cell carcinoma. The tumor was thus diagnosed to be adenocarcinoma originating from the vesical diverticulum and total cystectomy and urinary diversion (ileal conduit) were scheduled. At operation, the carcinoma was found to have infiltrated into the cecum. The operation procedure was therefore changed to partial cystectomy and excision of the cecum in consideration of both the patient's quality of life and her overall prognosis. Although a tumor originating from the vesical diverticulum and adenocarcinoma are both considered to be factors indicating a poor prognosis, no signs of recurrence or metastasis have been detected in this patient at 26 months after the operation.

Adenocarcinoma↗
PubMedDate not supplied

Diagnostic and treatment of Zenker's diverticulum: review of our series pharyngo-esophageal diverticula.

BACKGROUND/AIMS: Clinical aspects and preneoplastic potential of Zenker's diverticulum justify its surgery. The clinical signs of the patients and the size of the diverticulum determine the surgical technique. METHODOLOGY: Between January 1974 and December 1995, 32 patients underwent surgery in our department. In order to compare the surgical technique, we divided the patients into 3 groups: group A (cricopharyngeus myotomy: 15 patients (46.9%)), group B (myotomy with diverticulectomy: 15 patients (46.9%)) and group C (myotomy with diverticulopexy: 2 patients (6.7%)). The chi-square test was used for statistical analysis, p < 0.05. RESULTS: Local or regional anaesthesia was used in 7 patients from group A (46.6%); 5 patients from group B (33.3%) and all the patients from group C (100%). General anaesthesia was used in 8 patients from group A (53.4%), 10 patients from group B (66.7%) and 0 patients from group C (0%). The overall mortality was 0%. The mean postoperative stay in group A was 6 +/- 2 days (3-10 days); in group B was 11.6 +/- 6.4 days (5-25 days) and in group C was 3.5 +/- 0.7 days (3-4 days). The mean postoperative stay in patients with local or regional anaesthesia was 5.3 +/- 1.6 days (3-9 days) and in patients with general anaesthesia, 10.9 +/- 6.1 days (4-25 days). No statistically significant difference was found between the anaesthetic technique and the surgical technique (p = 0.193), between the surgical technique and the mean postoperative stay (p = 0.596) and between the anaesthetic technique and the mean postoperative stay (p = 0.166). CONCLUSIONS: Cricopharyngeus myotomy is the main surgical technique, however, in diverticula longer than 3 cm of diameter it is mandatory to associate diverticulectomy. Diverticulopexy is indicated in patients of advanced age with a high surgical risk. Local or regional anaesthesia facilitates the identification of the diverticulum intraoperatively and reduce the mean postoperative stay, however, there is no statistical significant difference.

Aged↗
PubMed1998

[Female urethral diverticulum].

Female urethral diverticulum is a rare condition. The reported incidence varies from 1.4-5%, depending on the population studied. The correct diagnosis is often delayed because of unspecific symptoms from the patients' lower urogenital tract. The classic triad of female urethral diverticulum is dribbling of purulent matter, dyspareunia and dysuria. The majority of patients have a palpable mass located on the anterior vaginal wall. The presentation and management of 11 women with urethral diverticulum who where admitted to the Surgical Department of the Central Hospital in Akershus during the period 1.1. 1975 to 1.4. 1996 is reviewed. Investigations included vaginal examination, urethrocystoscopy, urography and urethrography with a double balloon catheter. A palpable mass was found in all 11 patients. The urethrography was positive in eight out of ten patients. Diverticulectomy was performed on nine patients. In follow-up interviews from three months to 21 years after treatment, one patient was found to suffer from incontinence after surgery, two patients noticed recurrence of some symptoms, and six patients were completely relieved of their complaints.

Adult↗
PubMed1998

[A case of transitional cell carcinoma and milk of calcium in a pyelocalyceal diverticulum].

A 66-year-old man presented with right flank pain and macroscopic hematuria. Abdominal radiographs and computed tomography revealed a right pyelocalyceal diverticulum with milk of calcium and a soft tissue mass inside it. Other examinations, including positive urine cytology and negative random bladder biopsies, suggested a malignant tumor of the pyelocalyceal diverticulum. The patient underwent right nephroureterectomy. Histopathological examination revealed grade 3 transitional cell carcinoma. This is the first case of transitional cell carcinoma and milk of calcium coexisting in the same pyelocalyceal diverticulum.

Aged↗
PubMed1998

Acute Meckel's diverticulum in a senior patient.

Meckel's diverticulum is the most common congenital abnormality of the intestinal tract, occurring in 2% of autoptic studies. The case of an 85-year-old man referred to the Emergency Surgery Unit for intestinal obstruction and lower gastrointestinal tract bleeding is reported. Surgical exploration revealed a complicated Meckel's diverticulum full of coproliths, immersed in pus and blood. Examination of the resected diverticulum showed necrotic diverticulitis in the absence of ectopic gastric or pancreatic tissues.

Acute Disease↗
PubMed1998

[Spontaneous rupture of bladder diverticulum. Apropos of a case].

We report a case of spontaneous rupture of a bladder diverticulum. A 65-year-old man presented with urinary retention and serious infection. At clinical examination, the patient had a distended abdomen, tenderness of the left flank and left lumbar region and benign prostatic hyperplasia. Urinary catheterisation yielded bloody and purulent urine. CT scan showed a paravesical collection extending to the left lumbar region. Blood count showed anaemia and leukocytosis. Emergency surgical exploration found a large infected bladder diverticulum with necrosis and perforation of the wall. Treatment consisted of resection of the necrotic tissue and suture of the diverticulum neck. Convalescence was uneventful.

Aged↗
PubMed1999

Laparoscopic treatment of duodenal diverticulum.

A patient with a history of intermittent and intense pain in the upper abdomen secondary to an ulcer of a duodenal diverticulum underwent laparoscopic treatment. The diverticulum measured 2.5 cm in diameter and it was located on the lateral wall of the second portion of the duodenum. The diverticulum was inverted and the duodenal muscular defect was closed with interrupted sutures. Ambulation and a clear liquid diet was started on the same day as the operation, and the patient was discharged on the first postoperative day.

Adult↗
PubMed2001

Ventricular diverticulum at the posterior horn of the lateral ventricle presenting as aplasia cutis congenita.

Non-communicating hydrocephalus can cause rupture of the lateral or third ventricle, generally in the medial wall of the trigone or the posterior wall of the third ventricle, resulting in a cystic lesion known as ventricular diverticulum. In this paper, we describe a rare case of ventricular diverticulum located in the posterior horn of the lateral ventricle and expanding to bulge with a convexity reaching into the subdural space in a neonate. Aplasia cutis congenita and a bone defect were also present in the same neonate. Early surgical repair of the scalp defect and ventriculoperitoneal shunting were performed. In addition to illustrating the rare co-existence of a ventricular diverticulum at the posterior horn of the lateral ventricle and aplasia cutis congenita in a neonate, this case also offers new insights into the pathogenesis of these congenital anomalies.

Brain Diseases↗
PubMed2002

Zenker's Diverticulum.

The treatment of patients with a Zenker's diverticulum is endoscopic or surgical. Whichever procedure is chosen, the most important component of the procedure is a thorough cricopharyngeal myotomy. This can be accomplished either externally through a neck incision or internally with an endoscope. The endoscopic approach, which accomplishes only a myotomy and not a resection of the diverticulum, is most useful when the diverticulum is moderate in size. If the pouch is small, the endoscopic approach is riskier because there may be an inadequate protection against perforation of the pharynx; an external myotomy alone is preferable. If the pouch is large, then an external approach can accomplish both the myotomy as well as a diverticulopexy. If the pouch is extremely large, then an external myotomy and diverticulectomy would be the procedures of choice.

Journal Article↗
PubMed1997

Ruptured left ventricular diverticulum in infancy.

Congenital diverticulum of the left ventricle is rare, and rupture of such a diverticulum is even more rare. We describe successful surgical repair of a ruptured left ventricular diverticulum in an 11-month-old infant.

Cardiac Tamponade↗
PubMed1976

[Therapy of refractory ventricular tachycardia in congenital diverticulum of the left ventricle. Clinical aspects and surgical therapy of a rare malformation].

True congenital diverticulum of the left ventricle is an extremely rare lesion, usually associated with defects of the pericardium and the diaphragm. It is defined as a finger-like extension of the ventricular chamber with its wall consisting of all three layers of a normal heart-wall and with the ability to contract properly. Additional cardiac malformations may lead or contribute to early death; if not, the patients die from rupture of the diverticulum. To our knowledge the isolated form without pericardial defect has been reported only once before. The findings are described in an adult who presented with ventricular tachycardia at the age of 43 years. Complete normalization was achieved by resection of the diverticulum with the aid of cardiopulmonary bypass. The literature is reviewed for comparable cases. Etiological considerations are presented and the clinical features are discussed.

Adult↗
PubMed1998

Laparoscopic resection of a bleeding meckel s diverticulum: a case report and review of the literature.

The preoperative diagnosis of Meckel's diverticulum in adults is uncommon, and even more infrequent is the presentation of a bleeding Meckel's diverticulum after childhood. The case of a 22-year old, otherwise healthy male is presented here. The diagnosis was made by barium examination of small bowel and confirmed by diagnostic laparoscopy, followed by complete laparoscopic resection using an Endo-GIA Stapler (United States Surgical Corp., Norwalk, Conn.]. Histopathological examination of the specimen showed inflammed ileal mucosa with hemorrhages in several foci. The literature of Meckel's diverticula and its complications are reviewed here. Based on data from the reviewed literature and our own experience, we suggest that laparoscopic resection is the treatment of choice for Meckel's diverticulum, if it is diagnosed preoperatively or during diagnostic laparoscopy. The procedure allows for a smooth postoperative course, early discharge from the hospital, and arapid return to normal activity.

Journal Article↗
PubMed1996

Does a second bladder diverticulum require excision if the first contains a bladder tumor?

The multiplicity of bladder diverticula is well documented, yet review of the literature revealed only one reported case of cancer occurring in more than one diverticulum. To our knowledge, we report on the first long-term follow-up of a remaining bladder diverticulum after partial cystectomy for a transitional cell carcinoma in a contralateral diverticulum. The case report suggests that conservative management may be preferred for bladder diverticula not involved with tumor and routine prophylactic diverticulectomy may not be necessary.

Journal Article↗
PubMed1989

[Primary cancer of the vesical diverticulum in a patient with spinal cord injury: report of a case].

A case of primary cancer of the vesical diverticulum in a patient with spinal cord injury is reported. A 78-year-old man with L1 incomplete paraplegia, who complained of asymptomatic gross hematuria, was referred to our hospital on September 2, 1986. Urethrocystoscopy showed papillary tumor in the diverticulum and three small stones. Histopathological findings of the biopsied specimen of the tumor revealed transitional cell carcinoma grade 3. Partial resection of the bladder involving diverticulum with right ureterovesiconeostomy and right pelvic lymphadenectomy was performed on October 17, 1986. Histopathological findings revealed transitional cell carcinoma grade 3 with submucosal invasion into the muscular layer (pT3bINF beta, ly2, V (+]. Two courses of combination chemotherapy with cyclophosphamide, adriamycin and cisplatin were given as a postoperative adjuvant chemotherapy, however he died of pneumonia on January 2, 1987. There have been reported 11 cases of a vesical neoplasm in patients with spinal cord injury in Japan.

Aged↗
PubMed1988

[Perforation of a solitary diverticulum of the transverse colon. Contribution of preoperative x-ray computed tomography and echography].

Diagnosis of perforation of a solitary diverticulum of transverse colon followed the discovery at operation of an abdominal mass, ultrasound and CT scan imaging demonstrating a heterogeneous mass of enhanced density provoking apparent extrinsic compression of colon. A literature review showed the rarity of this complication, only 22 cases being reported but associated almost constantly with a pseudo-tumoral abscess centered on the diverticulum. This was the case in the patient reported but current imaging methods (ultrasound and particularly CT scanning) allowed correct evaluation of the nature and relations of the mass preoperatively, eliminating, its neoplastic nature by precise morphologic criteria. Despite its rarity, the diagnosis of perforation of an isolated transverse colon diverticulum should be evoked systematically by an extrinsic mass developed in contact with its wall, the nature of which is now simple to define preoperatively by CT scan imaging.

Diverticulitis, Colonic↗
PubMed1986

Primary neoplasm in a vesical diverticulum: analysis by step-sectioning.

A primary neoplasm arising in a vesical diverticulum was cystectomized and analyzed by step-sectioning of the whole bladder in an attempt to determine the carcinogenic process. Serial sections of the cystectomy specimen revealed a small area of mild dysplasia in the mucosa of the bladder and the diverticulum without a tumor. Most of the mucosal cells in the tumor-bearing diverticulum were desquamated, but a small area of dysplasia in the remaining cells was also observed.

Cystoscopy↗
PubMed1986

A case of intraluminal duodenal diverticulum associated with congenital biliary dilatation: a review of the literature in Japan.

A case of intraluminal duodenal diverticulum (IDD) associated with congenital biliary dilatation is reported. Patients with intraluminal duodenal diverticulum often have congenital anatomical abnormalities or acquired diseases. The treatment of the intraluminal duodenal diverticulum itself is easy, but it is important to detect and treat other disorders also present.

Biliary Tract↗
PubMed1994

Removal of the preputial diverticulum in swine.

A new technique for removal of the preputial diverticulum in swine was performed on 33 sexually intact male potbellied pigs, 12 domestic boar cadavers, and 4 domestic swine (2 sexually intact males and 2 barrows). With each pig under general anesthesia, the body and horns of the diverticulum were everted through the preputial orifice and excised. In some cases, the stump of the diverticulum was sutured. Remaining tissues were allowed to retract through the preputial orifice. The technique was more rapid than the conventional method because skin incision and blunt dissection were unnecessary. Although the technique was developed as a preventive sanitary procedure to accompany routine castration of pet pigs, it has application to domestic swine practice.

Anesthesia, General↗