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PubMed1996

[Sub-urethral diverticulum in women. Apropos of 12 cases].

The authors report a retrospective study of 12 cases of urethral diverticuli in women, observed over 17 years (1977-1994) at the department of urology in Casablanca. The mean age was 40 years. The reason of consultation was iterative cystitis (10 cases), the perception of the diverticulum by the patient in 50% of cases. The clinical examination permitted the diagnosis in all the cases. Intra-venous pyelography and retrograde cystogram led to a better analysis of the diverticulum. All our patients have been operated on by a vaginal approach, the resection of the diverticulum being made in 12 cases. During follow-up, one patient presented a recurrence, and another has been admitted for dilatation of a meatal stenosis.

Adult↗
PubMed1984

Surgical management for recurrent pharyngoesophageal (Zenker's) diverticulum.

Recurrent pharyngoesophageal diverticulum is uncommon after a one-stage diverticulectomy. Among 888 operations at the Mayo Clinic, recurrence has been noted after only 32 (3.6%). The present report outlines our management during a 19-year period of 44 patients operated on previously, including management of various late complications seen in 13 patients after diverticulopexy and diverticulectomy performed at other institutions. The study then focuses on the results in 31 patients in whom reoperation for symptomatic recurrent diverticulum was performed at the Mayo Clinic during the same period. Although reoperation posed a technical challenge, there was only 1 operative death (3.2%). Surviving patients experienced highly satisfactory late results, with only two recurrences. Early surgical morbidity was considerably higher than for primary operations, but this did not interfere with most patients having excellent to good late results.

Adult↗
PubMed2002

Endoscopic stapler-assisted diverticuloesophagostomy for Zenker's diverticulum: patient satisfaction and subjective relief of symptoms.

BACKGROUND: We assessed the results of endoscopic stapler-assisted diverticuloesophagostomy for Zenker's diverticulum, with emphasis on patient satisfaction and subjective relief of symptoms. METHODS: A retrospective cohort analysis was performed on all patients operated on from 1997 to 2000. Patients' charts were reviewed with respect to intraoperative and postoperative complications. The severity of preoperative and postoperative symptoms by patient self-assessment was compared by means of a 4-point scale (0-3) on a standardized questionnaire, as well as assessment of patient satisfaction (poor, fair, moderate, high). RESULTS: Thirty patients (22 men, 8 women) with a mean age of 72 years (range, 42-97 years) were part of the study. The mean follow-up was 13.2 months (range, 2-39 months). No major intraoperative or postoperative complications were observed. The most frequent preoperative symptoms were regurgitation of undigested food and dysphagia for solid consistencies (87%). Both of these preoperative symptoms were improved from a mean preoperative score of 2.2 and 2.7 to 0.1 and 0.4, respectively (P <.0001). Postprandial coughing (32%), halitosis (21%), and globus sensation (32%) were less common but also significantly improved. All but 1 patient (96%) were highly satisfied with the procedure. CONCLUSIONS: Endoscopic stapler-assisted treatment of Zenker's diverticulum offers a very low complication rate, a very high degree of symptom relief, and patient satisfaction.

Adult↗
PubMed1990

Massive bleeding in a Zenker's diverticulum.

Massive bleeding from a pharyngoesophageal diverticulum is a rarely reported condition, with only two reported cases in the literature. This report describes a patient who had massive bleeding due to ulceration in the base of a pharyngoesophageal diverticulum, presumed to have been caused by chronic aspirin ingestion. The diagnosis was made on upper gastrointestinal endoscopy, and surgical treatment (cricopharyngeal myotomy and diverticulectomy) was curative.

Aged↗
PubMed1957

Meckel's diverticulum: its clinical significance; a report of 54 cases.

Of 54 cases of Meckel's diverticulum observed at one hospital in a 20-year period, 27 were noted incidentally and 27 caused symptoms. In the latter group, the patients were preponderantly males. The most common symptoms, in order of frequency, were hemorrhage from the bowel, intestinal obstruction, acute diverticulitis, and intussusception. All the complications except intestinal obstruction occurred in infancy and childhood more often than in later life. Intestinal obstruction was limited to adults. There was strong coincidence of complications and ectopic tissue. Surgical excision was done in all cases of diverticulum causing symptoms, and all patients recovered.

Adult↗
PubMed1991

Cricopharyngeal myotomy with diverticulopexy for Zenker's diverticulum.

Prolonged cricopharyngeal dysfunction due to various causes can lead to severe dysphagia, aspiration, pneumonia, debilitation and subsequent pharyngoesophageal (Zenker's) diverticulum. This paper reports the successful use of cricopharyngeal myotomy with diverticulopexy for management of huge Zenker's diverticulum on five high-risk patients. The advantages of this method are immediate swallowing, short hospitalization, and avoidance of serious complication.

Aged↗
PubMed1984

[Myotomy (pars fundiformis m. cricopharyngei)in the treatment of Zenker's diverticulum. Report on 32 patients treated between 1972 and 1981].

11 patients were subjected to external operation with invagination of the pouch and myotomy; this procedure was chosen for younger patients, and small pouches with a broad spur. 21 patients were treated by cutting the spur of the diverticulum endoscopically; this intervention was preferred for older patients, and for larger diverticula with a narrow spur. Three of five recurrences were treated endoscopically. There were no complications, stay in hospital was short. Cutting the spur of the diverticulum relieves the cause of the patient's complaints. The endoscopic procedure can be repeated until satisfying results are obtained, even after previous external operations.

Adult↗
PubMed2003

Meckel diverticulum: a geriatric disease masquerading as common gastrointestinal tract disorders.

BACKGROUND: Meckel diverticulum (MD) is traditionally considered a pediatric disease that is associated with intestinal hemorrhage or perforation. Symptomatic MD is rarely a consideration in the geriatric population. OBJECTIVE: To notify clinicians of the clinical variety and diagnostic uncertainty of MD in the elderly, we report 7 cases of complicated MD that presented as common disorders of the gastrointestinal (GI) tract in patients older than 65 years. METHODS: A retrospective record review at 2 university-affiliated hospitals revealed 7 patients older than 65 years with MD and abdominal complaints necessitating laparotomy. The patients represented a subset of 27 adults (age range, 21-89 years; mean age, 39 years) with symptomatic MD who required surgery during a 7-year period. RESULTS: The presenting complaints represented a variety of common GI presentations, including nausea, vomiting, and acute abdominal pain (n = 3); acute abdominal pain with peritonitis (n = 2); crampy abdominal pain lasting several weeks (n = 1); and rectal bleeding (n = 1). Meckel diverticulum was a preoperative consideration in only 2 of 7 cases. The preoperative diagnoses were consistent with common disorders of the GI tract in the elderly, including small-bowel obstruction (n = 2), ischemic colitis (n = 1), unrelenting bleeding in the GI tract (n = 1), perforated viscus (n = 1), diverticulitis (n = 1), and appendicitis (n = 1). In contradistinction to the pediatric age group, only 1 of 7 patients had an MD with ectopic mucosa. CONCLUSIONS: Many different mechanisms can be responsible for complications due to MD in the geriatric population. Misdiagnosis occurs frequently in the elderly because of the poor sensitivity of diagnostic tests, nonspecificity of complaints, and lack of recognition that this anomaly can present in this age group. Clinicians must be cognizant of this common pediatric disease and its varied guises when they are evaluating unexplained acute or intermittent abdominal pain, nausea and vomiting, rectal bleeding, peritonitis, or obstruction in geriatric patients.

Abdominal Pain↗
PubMed1996

Prenatal diagnosis of a fetal ventricular diverticulum associated with pericardial effusion: successful outcome following pericardiocentesis.

Congenital cardiac diverticula are rare abnormalities that may occur as isolated malformations. In this report, we describe a case of an isolated congenital cardiac diverticulum complicated by a large serous pericardial effusion diagnosed ultrasonographically at 19 weeks' gestation. Therapeutic pericardiocentesis at 20 weeks' gestation resulted in complete resolution of the effusion with a normal fetal outcome. There is only one previous report of a prenatal diagnosis of a cardiac diverticulum complicated by a pericardial effusion and that patient underwent termination of pregnancy (Carles et al., 1995). Given the otherwise favourable prognosis for this lesion, and the excellent response in this case, pericardiocentesis should be considered in similar cases.

Adult↗
PubMedDate not supplied

Meckel's diverticulum mimicking infantile colic: sonographic detection.

We report a case of Meckel's diverticulum in a 6-month-old girl who presented with a 5-month history of chronic screaming but no symptoms or signs of intestinal obstruction. Infantile colic was the presumptive diagnosis. Abdominal sonography at 6 months of age demonstrated an abdominal mass with an anechoic center and a double-layered wall, surrounded by bowel loops. Abdominal CT and barium enema x-ray studies demonstrated nonspecific findings of a cystic mass with compression of adjacent bowel loops. Histologic examination of the resected mass revealed a Meckel's diverticulum with a perforation sealed off by the neighboring bowel and mesentery to form an inflammatory mass.

Colic↗
PubMed1984

Meckel's diverticulum. II. A novel lymphoepithelial organ in the chicken.

We have studied the lymphoid development and structure of Meckel's diverticulum (MD). The lymphoid accumulation began about 2 weeks of age. Between 2 and 5 weeks of age the longitudinal folds were filled with lymphoid tissue. The intensive germinal center formation occurred between 5 and 7 weeks of age. Germinal center formation was associated with the presence of secretory cells. The absence of the secretory cells in the germinal centers was followed by germinal center inactivity which was indicated by the lack of lymphoblasts and the high number of tingible body macrophages. The lymphoid tissue of MD seemed to be fully developed by 10 weeks of age and remained lymphoid at least until 21 months of age. Meckel's diverticulum produced large numbers of plasma cells which were comparable to those of the gland of Harder. We may regard MD as the third pouch of the intestine and suggest that it may be a novel lymphoepithelial organ in the chicken.

Aging↗
PubMed1975

Meckel's bleeding diverticulum diagnosed by mesenteric arteriography.

The details of a young adult patient who presented with chronic gastro-intestinal blood loss as a complication of Meckel's diverticulum are reported. A preoperative diagnosis was made using superior mesenteric arteriography. The merits of superior mesenteric arteriography and other investigations currently available in the diagnosis of Meckel's diverticulum are discussed.

Adult↗
PubMed1980

Meckel's diverticulum: its association with congenital malformation and the significance of atypical morphology.

Retrospective analysis of the records of a children's hospital shows an increased incidence of Meckel's diverticulum in children born with major malformation of the umbilicus, alimentary tract, nervous system or cardiovascular system in descending order. A consideration of the risks associated with Meckel's diverticulum suggests that elective resection is indicated only for diverticula that are atypical on inspection or palpation.

Abnormalities, Multiple↗
PubMed1980

The diagnosis of Meckel's diverticulum by small bowel enema in the investigation of obscure intestinal bleeding.

A diagnosis of Meckel's diverticulum was made by small bowel enema in a patient suffering from occult bleeding. Meckel's diverticulum is rarely seen on the standard small bowel follow-through and is unreliably detected by isotope studies in the adult. In the investigation of intestinal bleeding the diagnosis may be overlooked unless a small bowel enema is performed. It is recommended that it be performed before arteriography if colonoscopy is normal.

Enema↗
PubMed1982

Angiodysplasia and Meckel's diverticulum: a congenital association?

Five patients under the age of 21 years are described in whom a Meckel's diverticulum was found in association with angiodysplasia of the caecum or ascending colon. Angiodysplasia has only been observed previously in patients over the age of 35 years and its demonstration in 5 young patients with Meckel's diverticulum points not only to an association between the two disorders, but suggests that angiodysplasia may have a congenital aetiology.

Adolescent↗
PubMed1986

Meckel's diverticulum in the adult.

The management of Meckel's diverticulum (MD) incidentally detected in adults remains controversial. To assess the risk involved in excision of such diverticula and the incidence of complications arising from MD in adult life, we analysed 260 cases of MD found at laparotomy in a baseline population during a 15-year period. There were 148 symptomless and 112 symptom-producing diverticula, with intestinal obstruction as the most common complication. Assuming a 2 per cent general incidence of MD, the complication rate in these adult patients was 0.03 per cent per year. The calculated lifetime risk of complication from MD was 3.7 per cent at age 16 years, falling to zero in old age. Excision of an incidentally detected MD entailed a 6 per cent rate of major complications. Twenty-eight symptomless diverticula were not excised, and follow-up revealed no complications in these cases. In adults an incidentally discovered, symptomless Meckel's diverticulum should be left in place.

Adolescent↗
PubMedDate not supplied

Use of a linear stapler in excision of Zenker's diverticulum.

Zenker's diverticulum is an outpouching of the hypopharyngeal wall through a triangular area of weakness in the inferior pharyngeal constrictor muscle. The current treatment of choice is a one-stage diverticulectomy, with or without a cricopharyngeal myotomy. Closure of the esophagus after diverticulectomy by conventional suturing techniques may be somewhat difficult and time consuming. In the past 2 decades, use of stapling devices has been suggested in four reports, the largest being a series of four patients. We have used the Proximate disposable linear stapler in seven cases of Zenker's diverticulectomy with excellent results. Operation time was shortened, patient recovery hastened, and no complications were seen. We recommend the use of the stapling device in excision of Zenker's diverticulum.

Aged↗
PubMedDate not supplied

Inversion of Zenker's diverticulum: the preferred option.

A review of patients who had surgery for Zenker's diverticulum in our institution in recent years was conducted. A comparison of inversion versus excision of the sac shows that inversion carries lower morbidity and more rapid rehabilitation of swallowing than does excision. Inversion (plus cricopharyngeal myotomy) is to be preferred for diverticula that are neither too large to invert nor too longstanding to risk leaving subclinical carcinoma behind in the wall of the diverticulum.

Adult↗