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PubMed1999

Management of Zenker's diverticulum and postlaryngectomy pseudodiverticulum with the CO2 laser.

Dysphagia is a common symptom and can be caused by anterior pharyngeal (pseudodiverticulum after laryngectomy) and posterior pharyngeal (Zenker's) diverticula. The only treatment is surgical. The experience with an endoscopic treatment, especially with the CO(2) laser, is limited. Between 1984 and 1996, 81 patients with dysphagia were treated endoscopically with the CO(2) laser at the Department of Otorhinolaryngology-Head and Neck Surgery, University of Kiel. In 70 patients the swallowing disorder was caused by a hypopharyngeal diverticulum, and in 11 patients it was caused by a pseudodiverticulum after laryngectomy. In the Zenker's group, more than 90% of the patients were treated successfully. Eight of 11 patients with pseudodiverticula were without symptoms, and in the remaining 3 patients dysphagia was improved after laser therapy. The excision technique was superior to the incision procedures. The rate of postoperative complications was generally low. The microendoscopic approach with the CO(2) laser is a recommendable method for the treatment of Zenker's diverticulum and pseudodiverticulum in the postlaryngectomy patient. The surgical technique with the CO(2) laser at low power settings is a less invasive, quick, relatively safe, and effective procedure requiring only short hospitalization.

Aged↗
PubMed2000

Congenital ureteral diverticulum coexistent with hydronephrosis caused by vascular compression involving the uterine artery and umbilical ligament: report of a case.

Coexistence of congenital ureteral diverticulum and hydronephrosis caused by vascular compression is a rare entity. The authors experienced a case of congenital ureteral diverticulum coexistent with hydronephrosis caused by aberrant vascular compression by uterine and umbilical arteries in a 14-year-old girl. The authors could not diagnose accurately this abnormality preoperatively by 3-dimensional computed tomography. After partial ureterectomy, including resection of the saccular lesion and ureteroneocystostomy, the frequency of urinary tract infection decreased.

Adolescent↗
PubMed2001

Cystic Meckel's diverticulum: A rare cause of cystic pelvic mass presenting with urinary symptoms.

An atypical form of Meckel's diverticulum is presented. A 5-year-old girl was admitted with recurrent urinary tract infections. Ultrasonography showed a cystic mass, which pressed and displaced the urinary bladder on its posterosuperior aspect. Laparotomy results showed a cystic mass originating from the antimesenteric border of the ileum, which was attached tightly to the urinary bladder. It was diagnosed as a cystic Meckel's diverticulum, which had undergone abscess formation with preservation of the ileal mucosa in some areas and had severe inflammatory changes on its wall. The case is unique both in the mode of presentation and type of complication. J Pediatr Surg 36:1855-1858.

Child, Preschool↗
PubMed2002

Meckel's diverticulum perforation with intraabdominal hemorrhage.

Perforation of Meckel's diverticulum in children is a rare and serious complication. The authors report a case of a 3-year-old boy with perforation and hemoperitoneum caused by Meckel's diverticulum. Difficulty of preoperative diagnosis is discussed, indication for incidental diverticulotomy is established, and the literature is reviewed.

Abdomen, Acute↗
PubMed2002

Perforated congenital diverticulum of the sigmoid colon.

A case of perforation of a congenital sigmoid diverticulum producing diffuse peritonitis in a 4-year-old boy is presented. Physical examination showed an acute abdomen despite a normal computed tomography study. Successful surgical treatment was achieved by excision of the diverticulum, adjacent bowel, and an end-to-end anastomosis.

Anastomosis, Surgical↗
PubMed1977

Juxtaminorpapillary diverticulum associated with chronic pancreatitis.

A 69-years-old male with a juxtaminorpapillary diverticulum of Santorini in the duodenum and chronic pancreatitis is described. The patient had suffered from attacks of epigastric pain during the last 35 years. At recent admission to hospital he had also an elevated urinary amylase activity and a juxtaminorpapillary diverticulum, demonstrated by duodenoscopy and X-ray examination after administration of a contrast medium. Endoscopic retrograde cholangio-pancreatography (ERCP) showed changes of the pancreatic duct system compatible with chronic pancreatitis, a diagnosis which was confirmed by explorative laparotomy.

Aged↗
PubMed2001

[Comparison of 2 endoscopic surgery techniques for reliable therapy of Zenker diverticulum].

BACKGROUND: A mediastinitis or intraoperative bleeding are the most feared complications of the transoral laser assisted diverticulotomy of Zenker's diverticulum. To reduce these complications we developed a new endoscopic surgical technique and compared the results of this new method with the results of patients who we treated earlier. PATIENTS AND METHODS: At the department of Otorhinolaryngology, Head and Neck Surgery, University of Luebeck 68 patients suffering from a hypopharyngeal diverticulum have been treated since 1987. In 64 patients we performed an endoscopic diverticulotomy using a CO2-Laser and the Weerda distending diverticuloscope. Four of the Zenker's diverticulua had to be removed by an external approach. From 1987 to 1994 a five millimeter bar between pouch and hypopharynx after diverticulotomy was left and sealed with fibrin glue in the first 38 patients. From 1995 to 1999 the spur of the hypopharyngeal pouch of the other 26 patients was completely separated. Afterwards we sutured the mucosa between the pouch and the hypopharynx to close the opened mediastinal space and sealed the former spur with fibrin glue. RESULTS: Comparing both endoscopic methods we had to observe concerning our first method one mediastinitis, a rise of body temperature in 29 patients (76%) and we had to perform a revision diverticulotomy in three patients (8%). Our modified technique didn't cause any mediastinitis, a rise of body temperature did only occur in five patients (18%) and no patient had to undergo revision surgery. CONCLUSIONS: The transoral complete separation of the spur of the hypopharyngeal pouch with suturing the mucosa of the pouch and the hypopharynx causes good functional results and means a further reduction of complications and a further improvement of the endoscopic diverticulotomy. Our new instruments (Fa. K. Storz, Tuttlingen) will be demonstrated.

Adult↗
PubMed2002

Endoscopic therapy for Zenkers's diverticulum by means of argon plasma coagulation.

We describe a 80-year-old man who presented with progressive dysphagia because of a Zenker's diverticulum. Barium swallow study revealed a large posterior diverticulum with a distal stenosis of the esophagus caused by compression. Because the patient was a poor candidate for surgery an endoscopic therapy was performed. The Zenker bridge was divided by argon plasma coagulation in two sessions without any complication to allow an overflow. The patient remained asymptomatic to date for a follow-up of 6 months.

Aged↗
PubMed2003

[Laparoscopic treatment of small bowel obstruction with intussusception, volvulus and appendicitis caused by an inflammatory Meckel's diverticulum].

Indications and contraindications for diagnostic laparoscopy in cases of intestinal obstructions are discussed in connection with a 16-year-old patient's case report with small bowel obstruction including intussusception, volvulus and appendicitis caused by an inflammatory Meckel's diverticulum. The use of diagnostic laparoscopy in cases of intestinal obstructions is controversial. In the described case we performed completely laparoscopically the derevolving and desusception of the volvulus and intussusception, the appendectomy and resection of the diverticulum. The procedure itself and the postoperative course were uneventful.

Adolescent↗
PubMed2004

Endoscopic treatment of a mid-esophageal diverticulum.

Mid-esophageal diverticulum is a medical rarity. Only patients in whom the condition is symptomatic should receive treatment. Minimally invasive surgery via a thoracoscopic approach is currently the preferred treatment for the condition. This case report describes a 63-year-old woman with a symptomatic mid-esophageal diverticulum, which was successfully treated by endoscopic diverticulotomy using a needle-knife through a flexible endoscope.

Diverticulum, Esophageal↗
PubMed2005

Retroperitoneal perforation of a duodenal diverticulum with colonic necrosis -- report of a case.

Primary duodenal diverticula are usually asymptomatic. About 115 perforations have been reported, but none with right colon necrosis. We report a 45-year-old woman, with a five days history of high fever along with epigastric and periumbilical pain. Physical examination revealed right upper and lower quadrant tenderness with peritoneal signs. White blood cell count was 11 500/mm (3) while biochemical and hepatic biology tests were normal. Abdominal radiographs showed no pathologic findings. Ultrasound disclosed fluid in the lower pelvis. Computerized tomography revealed fluid collection in the right hepatorenal space. Intraoperative findings included purulent fluid in the lower pelvis, segmental necrotic changes of the right colon, and a perforated diverticulum on the antimesenteric border of the third part of the duodenum. Surgery consisted of right hemicolectomy and ileo-transverse anastomosis, diverticulectomy, and decompressive lateral duodenostomy at the second duodenal portion. The patient had an uneventful postoperative course. A contrast study from the duodenostomy tube on the 6 (th) postoperative day showed no leakage or obstruction. Duodenostomy tube was removed on the 14 (th) postoperative day. Histology confirmed the diagnosis of a primary duodenal diverticulum.

Abdomen, Acute↗
PubMed1995

Flexible endoscopic treatment of Zenker's diverticulum: a new approach.

BACKGROUND AND STUDY AIMS: In the past, a number of treatment modalities have been used for the management of a Zenker's diverticulum. These include transcervical diverticulectomy, myotomy, or laser or diathermy treatment via rigid endoscopes. Up to the present, no reports of the treatment of a Zenker's diverticulum with a flexible endoscope have been published. PATIENTS AND METHODS: In this study, we present the results of our first 20 patients (13 male; mean age 82 years) prospectively treated with a flexible endoscope applied through diathermy. All patients had significant symptoms such as dysphagia, recurrent aspiration pneumonia and/or weight loss. RESULTS: Treatment using a mean of three sessions per patient was successful, with a good symptomatic response in all subjects. There were no severe complications associated with the therapy. Four patients complained about a sore throat for a few days. During follow-up (mean 6-7 months), three patients died due to unrelated causes, and 17 remained asymptomatic. CONCLUSIONS: An important advantage is that it is possible to perform the treatment without general anesthesia, and therefore also in patients whose general health is poor. The technique can easily be performed in an interventional endoscopy unit. Our first experiences show that flexible endoscopic treatment is an effective and relatively safe method.

Aged↗
PubMed1984

Congenital diverticulum of the heart of biventricular origin.

An extremely rare diverticulum arising from both ventricles at the caudal end of the intraventricular septum was diagnosed in a 2.9 kg infant. The diverticulum was removed successfully while a coexisting ventricular septal defect was left open for further management. The types and complications of such diverticula are described and the need for early surgical intervention is stressed.

Diverticulum↗
PubMedDate not supplied

[Large bladder diverticulum or double bladder--diagnosis and differential diagnosis].

We report a case of a 13 year old boy with trisomy 21 syndrome who presented with recurrent urinary tract infections. A duplication of the urinary bladder was diagnosed by echography and x-ray examination with each portion of the duplicated bladder having its own uretral opening: Surgery and histology showed however the lesion to be a large diverticulum of the urinary bladder with the right uretral orifice being located in the wall of the diverticulum.

Diagnosis, Differential↗
PubMed1980

[Meckel's diverticulum (author's transl)].

Complications (inflammation, bleeding, perforation) occurred in 20 of 38 patients with Meckel's diverticulum. Complications were disproportionately common in children up to ten years of age. Because of the high mortality rate in the presence of complications (20%) it is recommended to search actively for Meckel's diverticulum during every upper-abdomen laparotomy, as long as the underlying disease and the operative procedure allow it.

Adolescent↗
PubMed2002

Endoscopic treatment of Zenker's diverticulum using CO2 laser.

OBJECTIVES: The objective of the present study was to review the technique of endoscopic laser-assisted esophagodiverticulostomy (ELAED) for the treatment of Zenker's diverticulum. METHODS: We reviewed 83 cases of ELAED performed for the treatment of Zenker's diverticuli during the past decade. RESULTS: ELAED-treated patients had a reduced hospital stay and were able to start an oral diet earlier than were patients who underwent other surgical procedures. Two (2.4%) of our patients developed small fistulas, which closed spontaneously. An additional 2 (2.4%) of our patients required conversion to an open approach due to inadequate endoscopic exposure, and 5 (6%) required a revision endoscopic procedure for persistent symptoms. CONCLUSIONS: Our series of 83 patients treated at 2 large academic centers during the past decade with an average follow-up of 4 years demonstrates that ELAED is a safe and effective procedure for the management of Zenker's diverticulum.

Belgium↗
PubMed2002

Laparoscopic resection of an esophageal epiphrenic diverticulum.

Epiphrenic diverticulum of the esophagus is an uncommon disease. In the light of the benefits of minimally invasive treatment of such a functional disorder, we used the laparoscopic approach for resection of an epiphrenic diverticulum. We found that laparoscopic repair of symptomatic esophageal epiphrenic diverticula is a safe and effective technique with minimal postoperative pain and morbidity. It should be considered as an alternative to the traditional transthoracic approach, and may become the standard technique.

Diverticulum, Esophageal↗