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Congenital right ventricular diverticulum associated with a ventricular septal defect: a rare echocardiographic finding.

A neonate presented on the first day of life with tachypnea and poor feeding. The infant's initial echocardiogram demonstrated outpouching of the lateral wall of the right ventricle (RV) associated with a large ventricular septal defect (VSD). At 9 days of age he was diagnosed with osteogenesis imperfecta (OI). Despite treatment with digoxin, diuretics, and captopril he required hospitalization twice during his first 2 months of life for congestive heart failure (CHF). The VSD was closed at three and one-half months of age without resection of the diverticulum and CHF symptoms resolved. At 26 months of age he is doing well despite the residual RV diverticulum. Congenital cardiac diverticula are rare forms of cardiac malformations and their echo-Doppler features are herein discussed.

Angiotensin-Converting Enzyme Inhibitors↗

Giant true diverticulum of sigmoid colon.

A case of giant true diverticulum of the sigmoid colon, manifesting as pain and abdominal mass is presented. The patient is asymptomatic after resection of the diverticulum and end-to-end anastomosis of the colon.

Aged↗

Push-and-pull enteroscopy using the double-balloon technique (double-balloon enteroscopy) for the diagnosis of Meckel's diverticulum in adult patients with GI bleeding of obscure origin.

BACKGROUND: Meckel's diverticulum (MD) occurs in 2-3% of the population. Although the clinical, histopathologic, and radiologic features of the complications of MD are well known, the diagnosis may be difficult before surgery. CASE REPORT: Three patients (age 22-34 yr, two women) presenting with gastrointestinal (GI) bleeding of obscure origin underwent multiple endoscopic and radiologic tests including capsule endoscopy and Tc-99m pertechnetate scintigraphy before push-and-pull enteroscopy using a double-balloon technique (double-balloon enteroscopy). Double-balloon enteroscopy was performed in all three patients using oral and anal approaches to evaluate the entire intestine. In one case, MD was detected using the oral route; the diagnosis was confirmed using the anal approach. In two patients, the lumen of MD was disclosed using the anal route. No procedure-related complications occurred. Push-and-pull enteroscopy was the only nonsurgical procedure that provided a precise diagnosis. All patients underwent surgical resection of the diverticulum. In one case, ectopic gastric tissue was found histologically. No further bleeding occurred during follow-up (6-9 months). CONCLUSIONS: Keeping the low sensitivity of Tc-99m scintigraphy in the adult population in mind, double-balloon enteroscopy might be the modality of choice in young adult patients with acute recurrent GI bleeding of obscure origin and a suspected diagnosis of MD.

Adult↗

Pitfalls in the differential diagnosis of a pelvic cyst: lessons from a post-menopausal woman with bladder diverticulum.

We present a case of non-obstructive bladder diverticulum in a 75-year-old post-menopausal woman. An ovarian cyst was previously suspected, which resulted in a futile exploratory laparotomy without making any definite diagnosis, 1 year earlier. During this admission, transvaginal ultrasound-guided cyst aspiration was arranged to determine the nature of the presumed 'recurrent' cyst and to relieve the symptoms. Prior to cyst aspiration, up to 700 ml of urine through urinary catheterisation and the gradual disappearance of the 'cyst' alerted us to the possibility of a bladder diverticulum, which was later confirmed by retrograde cystography. This case illustrates the lessons that despite considerable researches having been done on enhancing sonographic accuracy, diagnosis based on imaging alone is likely to be associated with multiple pitfalls. Recognising the common pitfalls and integrating clinical information and alertness with ultrasonic features remains the mainstay of sonographic differential diagnosis.

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Acquired urinary bladder diverticulum in a dog.

A neutered female chow chow aged six years and five months was evaluated for dysuria. An initial diagnosis of bladder distension and atony was made following physical, ultrasonographic and radiographic examinations. The problems did not resolve with medical management and exploratory surgery revealed a large bladder diverticulum. This report describes the radiographic findings and surgical repair of the acquired bladder diverticulum. The literature available on this condition is also reviewed.

Animals↗

An oesophageal diverticulum in a dog.

An 11-month-old male Miniature Poodle was found to regurgitate small volumes of fluid and food particles due to a diverticulum in the thoracic oesophagus. The diverticulum was removed surgically. Histologically the wall contained extensive scar tissue. Longterm recovery was uneventful and 5 months after surgery the dog is in good health

Anesthesia↗

Giant sigmoid diverticulum: clinical and radiological features.

Two case reports of giant sigmoid diverticulum associated with diverticular disease of the sigmoid colon are presented. The clinical and radiological features of 30 similar cases found in the literature are reviewed. Our two cases represent the largest recorded diverticulum and the oldest recorded patient with this condition.

Aged↗

Intraluminal duodenal diverticulum causing recurrent pancreatitis: treatment by endoscopic incision.

Intraluminal duodenal diverticulum is a recognised but rare cause of acute pancreatitis. This patient had three attacks of pancreatitis, each requiring a stay in hospital, within a four month period. The apex of the diverticulum was incised endoscopically, whereupon peas and food debris gushed from the incision site. The patient has had no further symptoms in the 12 months since the endoscopic procedure.

Acute Disease↗

Association between Meckel's diverticulum and Crohn's disease: a retrospective review.

The operation notes and pathology records of 294 consecutive patients who had right hemicolectomy for Crohn's disease were reviewed. A Meckel's diverticulum was found in 17 (5.8%) of these patients, 2-3 times the expected rate in the general population. At least 50% of diverticula in the normal population contain heterotopic mucosa, but none was found in those diverticula that were examined from this group. The increased prevalence of Meckel's diverticulum in patients with Crohn's disease confirms previous anecdotal reports, but the cause for the increased frequency remains unexplained. The significance of this finding is discussed.

Adolescent↗

Influence of surgery on deglutitive upper oesophageal sphincter mechanics in Zenker's diverticulum.

BACKGROUND/AIMS: To evaluate the role of upper oesophageal sphincter (UOS) compliance in dysphagia, the functional consequences of surgery were evaluated in eight patients with pharyngeal diverticula. The study examined the hypotheses that hypopharyngeal intrabolus pressure is an indicator of UOS compliance and that UOS opening and intrabolus pressure are normalised by surgery. METHODS: In eight patients and nine healthy controls, we measured the timing of swallow events, UOS relaxation, maximal UOS dimensions, intrabolus pressure, and trans-sphincteric bolus flow rates by simultaneous videoradiography and pharyngeal manometry. RESULTS: Bolus flow rates were not changed by surgery. Surgery significantly increased UOS opening (p = 0.0001) and reduced hypopharyngeal intrabolus pressure (p = 0.0001). The slope of the relation between sphincter area and intrabolus pressure was steeper in patients than controls and was normalised by surgery. Surgery had minor effects on basal UOS tone and timing of swallow events. CONCLUSIONS: Upper oesophageal sphincter compliance is poor in Zenker's diverticulum and is normalised by surgery. Hypopharyngeal intrabolus pressure, which correlates with resistance to trans-sphincteric bolus flow, is a useful indicator of UOS compliance. Intrabolus pressure may be a predictor of outcome after myotomy in pharyngeal dysphagia. Cricopharyngeal myotomy is a mandatory component of surgery for Zenker's diverticulum.

Aged↗

Congenital diverticulum of the left ventricle. Report of two unusual cases.

Of two infants with congenital cardiac diverticula one had a defect consisting of a submitral valvular diverticulum rather than the expected aneurysm. It was clearly shown by echocardiography as well as angiography and was associated with moderate mitral incompetence and a poorly functioning left ventricular wall. The second infant had an isolated apical left ventricular diverticulum with subnormal left ventricular function and severe mitral incompetence. Because of intractable congestive heart failure this infant underwent successful replacement of a dysplastic fibrotic mitral valve which on histological examination had myxomatous features. The association between congenital mitral disease and congenital apical diverticular may be related to race and sex.

Cardiac Catheterization↗

Meckel's diverticulum-rare complications and review of the literature.

Meckel's diverticulum is the most common congenital anomaly of the gastro-intestinal tract. It arises as a result of incomplete dissolution of the vitello-intestinal duct. Approximately 4% of patients with Meckel's diverticula develop complications, most commonly obstruction, gastro-intestinal bleeding and inflammation. We describe three unusual presentations of Meckel's diverticulum-perforation due to ingested foreign body, a smooth muscle neoplasm simulating an ovarian tumour, and a Littre's hernia.

Adult↗

Carcinoid tumour arising in a Meckel's diverticulum.

A patient with a carcinoid tumour arising in a Meckel's diverticulum and presenting with acute small intestinal obstruction is described. Review of previously reported cases indicates that the initial clinical presentation of carcinoid tumours occurring in a Meckel's diverticulum is usually similar to that of appendiceal carcinoids. While most carcinoids in Meckel's diverticula present as incidental findings at post-mortem examination or laparotomy, their metastatic potential and subsequent behaviour resembles that of other small intestinal carcinoid tumours.

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Slow-release potassium and perforation of Meckel's diverticulum.

A case of peritonitis following perforation of gastric-type mucosa in a Meckel's diverticulum is described. At laparotomy a wax core of a combined diuretic-slow-release potassium preparation was found extruding through the perforation and a further pellet was found free in the peritoneal cavity. Intestinal perforation due to potassium-containing drugs is recognized and led to the development of enteric-coated and slow-release delivery systems. The association of perforation of Meckel's diverticulum with a slow-release potassium perforation has not previously been described.

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