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An asymptomatic congenital cardiac diverticulum was seen on a routine chest film in a 45-year-old man. Right atrial and left ventricular cineangiography showed that the diverticulum communicated independently with both ventricles. There was no evidence of heart failure, arrhythmia, or mural thrombus, and surgery was not deemed necessary.
A diverticulum of the hepatic duct was found in a 25-year-old woman. Cholangiography revealed that the diverticulum was cystic in nature and contained several stones. Since the intrahepatic ducts are never seen at surgery, the authors stress the importance of preoperative and operative cholangiography in locating such anomalies.
99mTc-pertechnetate scintigraphy in a 67-year-old woman with chronic gastrointestinal bleeding showed an area of increased activity in the right lower quadrant which appeared at the same time the stomach was visualized. At first this was thought to be a Meckel's diverticulum; however, superior mesenteric angiography subsequently revealed a small arteriovenous malformation which proved to be the bleeding site on laparotomy. This false-positive finding emphasizes the importance of comparative evaluation of early and late images in scintigraphy for suspected Meckel's diverticulum.
Numerous reports have described the management of pyelocaliceal diverticula associated with milk of calcium renal stones. Traditionally, open surgical techniques to manage such diverticula have included marsupialization and fulguration of the diverticulum, or partial/total nephrectomy. Recently, however, these invasive procedures have been replaced by percutaneous techniques. We report a patient with spontaneous rupture of a pyelocaliceal diverticulum with milk of calcium renal stones, who was successfully treated with endourological procedures.
A case of gastric diverticulum arising in a patient who had previously undergone anterior lesser curve seromyotomy for chronic duodenal ulcer disease is reported. The endoscopic appearance of this lesion is described and the potential mechanisms of causation are reviewed. The clinical relevance of this rare finding is examined with emphasis on the need for an index of awareness of this abnormality on the part of endoscopists and in particular, on the risks of injudicious biopsy of such a diverticulum.
We report a case of a perforated sigmoid diverticulum abscess that was difficult to differentiate from an ovarian tumor. A 53-year-old woman was diagnosed with an ovarian tumor, but laparotomy revealed a perforated sigmoid diverticulum abscess and appendicitis, with normal ovaries.
Among embryonic aortic vascular malformations, persistence of a right aortic arch and aberrant left subclavian artery associated with a diverticulum of Kommerell is rare, and is estimated to occur in 0.1% of the general population. We report two cases of diverticulum of Kommerell in which tracheal compression due to the vascular ring induced respiratory symptoms such as asthmatic dyspnoea. This reminds us that at least a chest X-ray should be performed in newly diagnosed asthmatic patients, focusing on the trachea and upper mediastinum. In case of vascular abnormality, angiography and magnetic resonance are the best investigations to define the abnormal anatomy and guide surgery.
Carcinosarcoma of the bladder is a rare neoplasm composed of a mixture of malignant epithelial and mesenchymal components. The presentation and clinical course of an infiltrating carcinosarcoma located in a bladder diverticulum coexisting with prostatic adenocarcinoma in a 69-year-old man are described. We believe this to be the fifth report of true carcinosarcoma appearing in a bladder diverticulum.
A case of female urethral diverticulum is reported by the authors. It is a rare disease and about 31 cases have previously been described. An analysis is made in relation to the diverticulum of the urethra and to female urethral carcinoma. Emphasis is given on the semiology and the recently acquired diagnostic procedures, as these have led to an increased number of recognized cases. In the case presented, an extended resection and a definitive urinary derivation was performed, together with chemo- and radiotherapy. A follow-up of 2.5 years showed no signs of recurrence or metastases.
Urethral stone is a rare clinical entity and usually encountered in men with urethral stricture or diverticulum. They are exceedingly rare in females secondary to the low incidence of vesical calculi and short urethra. We report a very rare case of a primary giant calculus in a urethral diverticulum of a female.
Although numerous reports have described the complications associated with pyelocaliceal diverticula, rupture of a pyelocaliceal diverticulum is extremely rare. We present a case of spontaneous rupture of a pyelocaliceal diverticulum with ureteral calculus. After passage of the calculus, no extravasation was demonstrated without any surgical or manipulative procedure. The unusual etiopathological setting which predisposed to the occurrence of such a rare phenomenon is discussed.
We present a 68-year-old man with a huge bladder diverticulum associated with benign prostate hypertrophy treated with transurethral fulguration of the diverticular mucosa in combination with transurethral resection of the prostate. The procedure was well tolerated by the patient and unfavorable symptoms faded after this procedure. Follow-up cystogram demonstrated remarkable reduction of the diverticulum.
In the literature, various theories concerning the cause of Zenker's diverticulum have been propounded. I believe that an anatomic predisposition plays a prominent role in the pathogenesis. This conclusion will be discussed in light of a study of the literature and characteristics of a series of 646 patients with Zenker's diverticulum. The current methods of treatment by an external surgical approach, as well as the (micro)endoscopic procedures, are described.
A six-month-old female with a history of recurrent bronchopulmonary infections was admitted to the Montreal Children's Hospital in severe respiratory distress. Cardiac arrest ensued and although ventilation by mask was always possible during the resuscitation procedure, there was a confusing inability to aerate the lungs after successful intubation. A right-sided tracheal diverticulum was identified at autopsy. It was assumed, in retrospect, that the intubating tube entered and abutted against the wall of the diverticulum, thus obstructing its distal lumen. The embryology, morphology and pathophysiology of congenital tracheal diverticuli are discussed. This rare diagnosis should be entertained when successful intubation leads to ineffectual ventilation
Much discussion in the literature concerning Zenker's diverticulum is related to etiology. Various theories have been propounded, but no single conclusion is generally accepted. We believe that an anatomic predisposition plays a prominent role. Considerations for this conclusion will be discussed. In the otorhinolaryngology departments of University Hospital and Martini Hospital (Groningen, the Netherlands) 545 patients with a diverticulum were treated endoscopically since 1964. Initially we used the procedure described by Dohlman. With the increase in the number of patients, the technique and instruments used have improved. In 1981 we started to apply a microendoscopic procedure with a special double-lipped scope and the carbon dioxide laser. The rate of complications was very low, and 91% of the patients are highly satisfied. In view of our results, we feel justified in maintaining that endoscopic treatment is a relatively safe and effective method.
Endoscopic diverticulotomy for the treatment of Zenker's diverticulum has been reported infrequently in the literature and has engendered considerable controversy. Between March 1992 and September 1996, we attempted to treat 102 patients with endoscopic treatment for pharyngoesophageal diverticula. In 98 patients, the endoscopic surgery was successfully completed. Conversion to open surgery was required in 4 patients (3.92%). One cartridge of staples in 16 patients (16.32%), 2 cartridges in 78 patients (79.59%), and 3 cartridges in 4 patients (4.08%) were used, according to the size of the diverticulum; the median duration of the procedure was 20 minutes (10 to 60 minutes). No postoperative morbidity or mortality was recorded. Oral feeding was started following radiologic control after a median of 2 days; the median hospital stay was 4 days. The median follow-up is 16 months (1 to 45 months). Four patients operated on before the introduction of the modified stapler showed a persistent diverticular pouch: 3 underwent repeat endoscopic operation, and 1 underwent conventional open surgery. All treated patients are asymptomatic. Manometric study performed in 15 patients showed a significant reduction of basal upper esophageal sphincter pressure compared to preoperative data (48.30+/-21.74 versus 29.38+/-5.68 mm Hg; p<.01). We therefore recommend endoscopic diverticulotomy, considering that the procedure is relatively safe and effective, with minimal patient discomfort, and the results are equal to those of the external approach. This procedure offers the advantages of short hospitalization, rapid convalescence, brief operative time, absence of skin incision. predictable resolution of symptoms, and reduced morbidity.
Meckel's diverticulum is the most common congenital malformation of gastrointestinal tract. It can cause complications in the form of ulceration, haemorrhage, intussusception, intestinal obstruction, perforation and, very rarely, vesicodiverticular fistulae and tumours. These complications, especially bleeding, are more common in the paediatric age group than in adults; however it is not uncommon to miss the diagnosis of Meckel's diverticulum in adults. Here, we reviewed the literature regarding the complications of this forgotten clinical entity in adults with potential diagnostic difficulties and management strategies.
Tc-pertechnetate scintigraphy was performed in 81 infants and children, clinically suspected to have Meckel's diverticulum with ectopic gastric mucosa. The predominant symptom was rectal bleeding and anemia. Twenty-two patients underwent laparotomy and 12 had Meckel's diverticulum with ectopic gastric mucosa. In operated patients the sensitivity of scintigraphy in detecting ectopic gastric mucosa was 0.75, the specificity 1.0 and the diagnostic accuracy 0.86; the diagnostic accuracy was estimated to 0.96 for the whole material. Histologic examination of the diverticula showed a smaller area of the ectopic mucosa in cases with negative scintigraphic findings. In addition, prominent fibrosis seemed to be a more consistent finding in cases with negative as opposed to those with positive scintigraphic findings. Presence of anemia may provide a guideline as to whether or not scintigraphy is indicated.