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Bleeding Meckel's diverticulum diagnosed with 99mTc-pertechnetate.

The diagnosis of bleeding Meckel's diverticulum in an 11 year old boy, an 8 year old girl and a 2 1/2 year old boy, was established preoperatively using 99mTc-pertechnetate. These abdominal scannings were of value in the management of patients with rectal bleeding after ruling out other disorders by hematologic tests, usual radiologic studies and endoscopic examinations. To reduce ambiguities, the scanning was performed with the child in a fasting state and a nasogastric tube was led into the stomach to minimize volume and flow of radioactive gastric juice into the intestinal tract. Based on our experiences and review of reported cases, applicability of the scanning in the management of patients with Meckel's diverticulum is discussed.

Child↗

Isolated congenital left ventricular diverticulum.

Congenital diverticulum of the left ventricle, a rare malformation, is usually associated with midline thoracoabdominal defect. We describe a case with congenital left ventricular diverticulum presenting as an isolated lesion. The lesion was suspected on two-dimensional echocardiography and was confirmed by cardiac catheterization and magnetic resonance imaging.

Child↗

Stone formation in a female urethral diverticulum. Review of the literature.

A case of stone formation within a female urethral diverticulum is presented together with a brief literature review. Clinical diagnosis may be suspected if a stony hard mass is palpable on the floor of the urethra. The definitive diagnosis depends upon a plain X-ray film and a retrograde positive pressure urethrogram. Surgical excision of the diverticulum together with the calculus is best performed by the vaginal route.

Diverticulum↗

Angiographic demonstration of bleeding in a unusually located Meckel's diverticulum simulating colonic bleeding.

A case is reported in which bleeding from a Meckel's diverticulum was mistakenly localized to the hepatic flexure of the colon on superior mesenteric angiography. An unusually long and mobile mesentery, allowing the bleeding Meckel's diverticulum to be positioned high in the right upper quadrant, led to this misdiagnosis. The case illustrates several fundamental principles about the technique and interpretation of mesenteric angiograms.

Adult↗

Adenocarcinoma arising in a sigmoid diverticulum: report of a case.

A case of adenocarcinoma arising in a sigmoid diverticulum is presented. A patient who had colonic diverticulosis was found to have one diverticular lumen distended by tumor mass. Microscopically, this was seen to be adenocarcinoma arising from the diverticular mucosa. Apparently, this is the first reported case of adenocarcinoma arising in an intact diverticulum of the colon.

Adenocarcinoma↗

Giant colonic diverticulum.

BACKGROUND: Over 100 giant colonic diverticuli have been recorded in the literature to date. The magnetic resonance imaging (MRI) and pathophysiology of their aetiology have rarely been described. AIM: To report a giant colonic diverticulum along with the MRI of this clinical entity. RESULTS: An 87 year old female presented with symptoms of tenesmus, urgency and alteration in bowel habit. A type I giant colonic diverticulum was diagnosed and a segmental colonic surgical resection was performed. The plain abdominal radiograph, barium enema and MRI, along with classification and management options are presented. CONCLUSION: Giant colonic diverticuli are rare surgical curiosities that may be successfully treated with either primary segmental or extended colonic resection.

Aged↗

[Mediastinoscopic diagnosis and drainage of pericardial diverticulum--a case report].

A 38-year-old male was suspected of having an enlarged pretracheal lymph node on chest CT scan. At mediastinoscopy, a cystic lesion was recognized, and showed repeated dilatation and contraction synchronously with the cardiac beat. Pneumopericardium was demonstrated by intraoperative pneumocystography. The cystic lesion was diagnosed as pericardial diverticulum. The diverticular wall was partially resected for drainage of the pericardial fluid. Mediastinoscopy as a less invasive procedure may be useful for the differential diagnosis of adenopathies, and in case of lesion such as a small pericardial diverticulum may allow treatment.

Adult↗

[One stage operation for aneurysm of the diverticulum of the ductus arteriosus and coronary artery bypass grafting].

Aneurysm of the diverticulum of the ductus arteriosus in the adult is rare. One stage operation for aneurysm of the diverticulum of the ductus arteriosis and coronary artery bypass grafting (CABG) is reported. A 61-year-old man was admitted for diagnosis of thoracic aneurysm on chest X-ray and CT. Chest CT scan showed an aneurysm above the left main pulmonary artery. An aortography showed the left vertebral artery originated directly from the aortic arch and a saccular aneurysm arising from the aortic isthmus and lesser curvature of the aortic arch. Coronary arteriography showed 75% stenosis at the right coronary artery (seg. #1) and 75% stenosis at the left anterior descending artery. Operation was performed through a median sternotomy. The aneurysm of 6 to 3 cm was located between the aortic isthmus and left pulmonary artery. Ascending aorta and right atrium were used to institute cardiopulmonary bypass (CPB). CABG (LITA to #7, SVG to #4 PD) was performed. Arterial cannulation was then switched to the left femoral artery. The proximal aorta was cross-clamped between the left vertebral artery and the left subclavian artery under the partial CPB, and the distal aorta was occluded with a occulusive balloon catheter via the right femoral artery. The selective left axillar artery cannulation was performed to perfuse LITA. The aneurysm was resected and closed with a patch. His post-operative course was uneventful.

Aortic Aneurysm↗

[Differential diagnosis of acute appendicitis and ileus. Invagination due to polypoid heterotopic gastric mucosa in the ileum without Meckel diverticulum].

A 13-year-old female presented with recurrent, right-sided abdominal pain since the age of 2 years. Examination showed a tender, cylindric mass in the right lower quadrant. Ultrasound and MRI revealed an ileocolic intussusception. On laparotomy, there was an ileo-ileal intussusception due to a 3.8-cm polypoid tumor about 40 cm proximal to the ileocoecal valve. Histology showed polypoid heterotopic gastric mucosa with no Meckel's diverticulum. To our knowledge, only 12 cases of intussusception of heterotopic gastric mucosa in the ileum without Meckel's diverticulum have been reported in literature. This case adds to this small list and represents a possible cause of intussusception.

Abdomen, Acute↗

[Diverticulum of the ductus arteriosus. Cause of traumatic aortic ruptures?].

INTRODUCTION: According to angiographic studies 9-26% of all adult aortae show a ductus arteriosus diverticulum (DAD), i.e. an indention of the aortic wall at the insertion of the obliterated ductus arteriosus. This region is predisposed for traumatic aortic rupture. Up to now fixation at the transition from aorta transversa to fixed aorta descendens is regarded as cause. It is unclear whether ductus diverticulum favours traumatic aortic rupture. MATERIAL AND METHODS: A total of 143 thoracic aortas (female symbol:37; male symbol:106, 17-91 years) were scanned histomorphologically for DAD. Calcification was quantified by CT multislice volume scan. RESULTS: A DAD was detected in 44% of macroscopically non-calcified and slightly calcified aortic specimens. Histologically, autochthonal elastic and collagenous fibres of the media were disrupted. CT in macroscopically non-calcified aortas proved isolated calcification in 78%. DISCUSSION: The incidence of 44% DAD-higher than in angiographic studies-can be explained by the method (histopathology), allowing diagnosis of diverticula down to microm. These morphological alterations are to be seen, at least in part, as a causative factor for the predilection to traumatic aortic ruptures.

Adolescent↗

[Traditional extraluminal operation for Zenker's diverticulum].

The classical surgical approach for the treatment of Zenker's diverticulum consists of diverticulectomy and cervical myotomy. In very small diverticula myotomy alone is sufficient. The complication rate of the procedure is tolerable. Long-term functional results are good in as much 90% and more. Despite the increasing importance of alternative approaches, the conventional extraluminal surgical operation for Zenker's diverticulum will remain the treatment of choice in stage I-III cases.

Endoscopy↗

[Intraluminal therapy for Zenker's diverticulum].

A Zenker's diverticulum (ZD) is a posterior diverticulum with its neck proximal to the cricopharyngeal muscle. Patients typically present after the age of 60 with symptoms ranging from weeks to years. The classical treatment in the past was surgical, which is still the case in the US. They treat them in general with open myotomy and diverticulectomy. Since the 1950s ENT physicians treat them with rigid endoscopes and cut the bridge between the ZD and the esophagus. This method is widely used throughout western Europe. However, many symptomatic elderly patients are poor surgical/ENT candidates. In 1995, two groups from Brazil and The Netherlands reported their first results with a gastroscopic treatment, in which the ZD bridge is cut with a precut needle/monopolar forceps. Recently, argon plasma coagulation has also been introduced in this field. All these treatments seem effective. Comparative trials between these approaches are now long overdue, since all these modalities will work in the hands of experienced "Zenker specialists".

Argon↗

[Differential diagnosis of inguinal hernias in combination with bladder diverticulum].

In patients with clinical findings suspicious for an inguinal hernia in combination with obstructive or neurogenic bladder dysfunction, herniation of bladder diverticula should be taken into consideration. This differential diagnosis is demonstrated by two case reports. In the patient with the hernia caused by obstructive micturition, we performed transurethral resection of the prostate (TUR-P) prior to resection of the diverticulum. Spontaneous micturition was possible after surgery. In the patient with the neurogenic bladder, we did the hernia repair and resection of the diverticulum primarily.

Aged↗

[Ventral urethral diverticulum. Case report of a 10-year-old girl].

In total urethral diverticula in children represent a very rare urological disorder. Primary localisation is the dorsal side of the urethra, ventral located diverticula are extremely rare. We report on a ten year old girl with a ventral, urethral diverticulum presenting with the symptoms of persisting enuresis. The diverticulum was excised through a median laparatomy. Placement of suprapubic catheter facilitated adequate postoperative drainage and postoperative cystourethrography confirmed the absence of extravasation.

Child↗

Dysphagia lusoria caused by aberrant right subclavian artery, Kommerell's diverticulum, legamentum ring, right descending aorta, and absent left pulmonary artery: a report of a unique vascular congenital disease undetected until adulthood and a review of the literature.

An active otherwise healthy and middle-aged woman presented with left supraclavicular pulsation, right upper extremity claudication, and mild dysphagia. Evaluation revealed an aberrant right subclavian artery, Kommerell's diverticulum with aneurysmal degeneration, legamentum arteriosum completing vascular ring, and absent left pulmonary artery with multiple collateral supply to the left lung. She underwent successful surgical repair via right thoracotomy, including division of the vascular ring, resection of the diverticulum and aneurysm, and finally reimplantation of the right subclavian artery to the aortic arch. Her symptoms resolved completely, and she was able to resume normal activities.

Aortic Arch Syndromes↗

A fading Meckel's diverticulum: an unusual scintigraphic appearance in a child.

We describe the case of a 13-month-old boy with significant rectal bleeding in which the (99m)Tc pertechnetate scan showed an initial focus of uptake in the left iliac fossa, which faded rapidly at 15 min. At surgery an ulcerated Meckel's diverticulum was found. We therefore highlight the need to consider a Meckel's diverticulum in cases where this atypical scintigraphic appearance is seen.

Digestive System Surgical Procedures↗

Torsion of a Meckel's diverticulum: sonographic findings.

There are few reports of the sonographic appearance of Meckel's diverticulum. We present a case of torsion of a Meckel's diverticulum that was suggested by sonography and confirmed pathologically. We discuss the sonographic differential diagnosis, which includes acute appendicitis, enteric duplication cyst and intestinal volvulus.

Child, Preschool↗