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Meckel's diverticulum is the most common congenital gastrointestinal anomaly. It may infrequently cause bleeding, perforation, or rarely obstruction. Formation of enteroliths in the diverticulum is uncommon. We present a case of small bowel obstruction from an expelled enterolith.
The existence of a vesical diverticulum in the context of a congenital connective tissue disorder such as Ehlers-Danlos syndrome led us to consider the possibility of a relationship. Four types of diverticula can be found in the literature: congenital, acquired, iatrogenic and syndrome-associated. Within the later, Ehlers-Danlos syndromes type IV and IX, even type V, are associated to the existence of vesical diverticula. The potential spontaneous rupture of the diverticulum is a typical feature, as well as post-surgery relapse. The attitude towards such diverticula should be one of watchful waiting, and simple, plasty-free diverticulectomy on the bladder's neck is indicated when performing a surgical procedure.
Meckel's diverticulum is a persistent embryonic remnant occurring in 2% of the general population. As an "ileal appendix", it is usually clinically silent and only discovered at the time of complications: inflammation, hemorrhage, obstruction, tumor. The preoperative diagnosis is rarely made because of the non specific nature of the symptomatology and only about 10% of complicated cases are diagnosed at imaging. Complications from Meckel's diverticulum should always be considered in patients presenting with an acute abdomen, especially in young adults.
Congenital cardiac diverticulum is a rare malformation formed by an outpouching of the ventricular wall, in particular the left ventricle. The thoraco-abdominal type is more frequent than the isolated thoracic type. Topographical and imaging considerations regarding an isolated congenital left ventricular diverticulum incidentally discovered in a 9-year-old-boy are reviewed.
A 50-year-old woman was the victim of a motor vehicle accident. An aortogram obtained for suspicion of an aortic injury was interpreted as an intimal disruption at the level of the aortic isthmus. At thoracotomy the patient was found to have only a ductus diverticulum. A brief discussion of the angiographic appearance of a ductus diverticulum and its significance in the setting of trauma is presented.
The barium appearance of intraluminal duodenal diverticulum has been classically described as a "windsock" appearance. However, the CT-scan appearance of this abnormality has not been well documented. A case report of a patient with intraluminal duodenal diverticulum is presented. The authors believe the CT-scan findings in the patient are virtually pathognomonic for this lesion and propose the term "halo" sign be applied to this previously undescribed finding.
A 74-year-old woman presented with severe dyspnea without dysphagia. Computed tomographic scans and Digital subtraction angiography revealed the left aortic arch with an aberrant right subclavian artery arising from the Kommerell's diverticulum and tracheal compression. The aortic arch and the Kommerell's diverticulum were aneurysmal and were responsible for this compression. Surgical relief was accomplished by replacement of the aortic arch and reconstruction of the four brachiocephalic vessels with vascular prostheses through a median sternotomy incision extending into the right supraclavicular region.
The pharyngeal orifice of the equine auditory tube has not been adequately described. Its larger size and position, further rostral within the nasopharynx compared with other species, cannot be easily explained, but could be important for the proposed brain-cooling function of the guttural pouches; however, unlike other species, it may not be the sole regulator of auditory tube aeration. A 'second orifice' (representing the final entrance to the auditory tube diverticulum) deserves recognition in performing a role in air exchange between the auditory tube, diverticulum and middle ear. The results of this investigation suggest that regular guttural pouch ventilation during resting respiration does not occur. Previous reports may reflect, at least in part, a misinterpretation of air pressure measurements within the guttural pouches and nasopharynx. Small decreases in simulated inspiratory pressure consistently caused the passive opening of both the pharyngeal orifice and pouch ostium in horse cadavers suggesting that an active counter process may exist in the live horse to maintain closure of the guttural pouch openings during rest and light exercise. Intrinsic tone of the stylopharyngeus and pterygopharyngeus muscles may be part of this active process. The investigation offers theoretical evidence that opening of the equine auditory tubes to ventilate the guttural pouch occurs in two different ways, active and passive. The active process has two stages: (1) opening of the pharyngeal orifices by simultaneous contractions of the levator and tensor veli palatini and pterygopharyngeus muscles; then (2) opening of the pouch ostia by contractions of dorsal portions of the palatopharyngeus muscles. The alternative passive route involves reduction in tone of the stylopharyngeus and pterygopharyngeus muscles accompanied by increased inspiratory pressure.
The most common anomaly of the aortic arch is the occurrence of a left aortic arch with an aberrant right subclavian artery. Other, less common anomalies have also been described. These include the occurrence of a right aortic arch with an aberrant left subclavian artery that, in addition, has a diverticulum at its site of origin known as Kommerell's diverticulum. All cases described in the literature have occurred in individuals younger than 35 years of age, generally with symptoms related to tracheal or esophageal compression. We present the case of a patient diagnosed by chance with this rare anomaly at 75 years of age.
The case of a 22-year-old male who bled from a Meckel's diverticulum is described. The diagnosis was achieved after 99mTechnetium pertechnetate scintigraphy. With the administration of somatostatin very clear images were obtained. The histological examination confirmed the presence of ectopic gastric mucosa. The literature, over the last 10 years, has been reviewed to identify factors associated with bleeding in adults. Ectopic gastric mucosa is the most important factor predicting bleeding. The diagnostic approach to bleeding Meckel's diverticulum and the improvement in the quality of 99mTechnetium pertechnetate scintigraphy, following administration of somatostatin, is discussed.
Spontaneous perforation of the oesophagus is a rare occurrence that is usually due to vomiting and is seldom associated with an oesophageal lesion. We report a case of the spontaneous perforation of a large oesophageal diverticulum not preceded by any precipitating event in a 75-year-old male who was not known to have achalasia. The diverticulum was repaired by emergency surgery. Achalasia was later diagnosed and successfully treated with botulin toxin injection. Surgery decision-making and the treatment of achalasia are discussed.
A 46-year-old female underwent a fluorodeoxyglucose F-18 (FDG) positron emission tomography (PET) whole-body scan for tumor screening after showing no symptoms or signs. The PET images showed a large FDG-avid lesion in the left renal pelvis, with a maximum standard uptake value (SUV) of 10.7 at 1 hour and 3.9 at 3 hours. An abdominal computed tomography (CT) scan showed a 3.7-cm cystic lesion with a slightly irregular wall in the left kidney. The immediate impression was that of a complicated cyst. A histopathologic report after surgery confirmed a calyceal diverticulum. To the best of our knowledge, this is the first report of FDG uptake in a case of calyceal diverticulum.
An obese patient, not diabetic, treated with metformin for some weeks, was referred to us with severe inferior digestive hemorrhage, diagnosed with Meckel's diverticulum. Metformin is described as a glucose-lowering agent for treatment of type 2 diabetes mellitus and as antiobesity drug, though results achieved with this last indication are not conclusive. But metformin has fibrinolytic features by means of diminished plasminogen activator inhibitor 1 activity. Although no coagulation study was done and the Meckel's diverticulum is normally associated with bleeding, the particular intensity of the following hemorrhage may have been favored by metformin.
Stromal tumors are rare neoplasms of the small bowel that locate in Meckel's diverticulum with high preference. Perforation of those tumors is very uncommon. There are 96 cases reported in current literature, including only 6 perforations. The diagnosis of that kind of tumor is very difficult because of lack of pathognomonic signs and symptoms. The clinical presentation include abdominal pain, intestinal bleeding, abdominal mass, intestinal obstruction and less commonly, acute perforation. We report the case of a 61-years old patient with a poorly differentiated stromal tumor in a perforated Meckel's diverticulum. The difficulty of identifying a stromal tumor preoperatively and the therapeutic options are emphasised. It is suggested that an aggressive attitude should be taken in the preoperative management of any patient over 50 years of age who presents with melena and abdominal pain.
Diverticula of the duodenum are not rare and in the most cases without any symptoms. The incidence of duodenal diverticula in autopsies is known to be 20-22%. Only in a very small number of cases, they are complicated and therefore clinically presented by diverticulitis, perforation, hemorrhage, pancreatitis, or biliary obstruction. The most uncommon complication is the enterolith formed within the diverticulum. In all reported cases, the enterolith--formation was associated with small bowel obstruction or perforation. Complications of duodenal diverticula have a high mortality rate (33-48%) that could be due to difficulties in diagnostics and the adequate surgical procedure. In our case report, a patient presented at our institution with symptoms of an acute abdomen caused by an enterolith inside a solitary duodenal diverticulum "ante perforationem". The ultrasound and the CT scan of the abdomen showed free intraabdominal fluid beside the duodenum, the exact diagnosis however was not made. The indication for laparotomy was given by the clinical signs. The dicerticula was resected and ligated.
Herein, we report on an adult with intussusception of an invaginated Meckel's diverticulum presenting mainly with acute intermittent lower gastrointestinal bleeding, whereas the common symptom of abdominal pain, indicating intussusception, was absent. Colonoscopy revealed a reducible polypoid lesion in the ileocecal area. Computed tomography led to suspicion of an intussusception. Surgical resection revealed a Meckel's diverticulum containing an aberrant pancreas. The unique clinical symptoms and the methods of diagnosis are discussed.
A case report is presented of an 86-year-old man in a very poor general condition with a 10-year history of a Zenker's diverticulum as a cause of a complete obstruction of the esophagus with subsequent aphagia and massive cachexia. Because of high surgical risk and contraindications to general anesthesia, an approach with the flexible endoscope to perform cricopharyngeal myotomy was undertaken. Several attempts with the flexible endoscope by experienced investigators had been performed until the esophageal inlet was intubated and argon plasma coagulation could be applied in several sessions to divide the tissue bridge between the esophagus and the Zenker diverticulum to successfully restore the pharyngoesophageal passage.
Our experience with videolaparoscopic operations for hiatus hernia and achalasia, which have almost replaced classical procedures, enabled us to use the same technique for other interventions in the distal third of the thoracic esophagus. Thus, we were able to treat epiphrenic diverticulum using a minimally invasive approach. We report our experience with videolaparoscopic diverticulum resection. The procedure was performed in three patients, all of them elderly men with ventilation limitation and a history of a chest intervention. The procedure included myotomy and an antireflux procedure. No significant complications occurred during the operations or postoperative periods; a minor leak that was successfully managed conservatively occurred in one patient. We conclude that videolaparoscopy could be a possible alternative to the standard classical left-side thoracotomy approach for patients in whom a classical operation is not feasible.