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In presenting the case of a 61-year-old man with a primary squamous carcinoma in a bladder diverticulum, the authors stress the usefulness of applying all the available modalities of imaging, since it has been found that a bladder diverticulum may harbor a neoplasm more often than a normal bladder.
The authors report a case of symptomatic arachnoid diverticulum, which was located anterior to the spinal cord and covered the entire length of the spinal canal. The patient underwent cervical laminectomy and cystoperitoneal shunting with subsequent neurological improvement. The causes, clinical manifestations, diagnosis, and management of spinal arachnoid diverticulum are discussed.
Meckel diverticulum, the commonest congenital abnormality of the gastrointestinal tract, may be difficult to diagnose. Appearances on CT are often non-specific unless there is connection to the umbilicus or a complication has occurred. We report a case of an inflamed Meckel diverticulum seen on CT.
The incidence of tumours within a Meckel's diverticulum is 0.5-3.2%. Their pre-operative diagnosis is rare. We report a case of an incidentally found gastrointestinal stromal tumour within a Meckel's diverticulum in a patient presenting with acute appendicitis. The tumour was demonstrated pre-operatively by ultrasound and CT.
It is somewhat surprising that endoscopic treatment of hypopharyngeal diverticula has failed to become as widely known as the method merits in our opinion. In principle we use the Dohlman procedure. The septum between diverticulum and esophageal lumen is divided with a diathermic knife after electrocoagulation. In larger diverticula we prefer to divide the tissue bridge in several sessions. Endoscopic treatment (under local anesthesia, if necessary) can be carried out in patients whose general condition is poor. From 1964 until 1980 we have endoscopically treated 211 patients, including 6 patients with a recurrent diverticulum after transcutaneous surgery. The complication rate is low and the complications were successfully controlled except in 1 patient, who died from cardiac failure 2 days after operation. Ultimately 193 patients (91.5%) are very satisfied and 17 patients (8%) are fairly satisfied with the therapeutic result. We feel justified in maintaining that endoscopic treatment of hypopharyngeal diverticula can be regarded as a good method of treatment.
We describe three cases that presented with symptoms suggestive of appendicitis but were found at operation to have an inflamed solitary caecal diverticulum. All were treated successfully with diverticulectomy or inversion of the diverticulum. We wish to highlight this diagnosis and its surgical management so that informed decisions can be made if this is first encountered in the operating theatre.
A 32-year-old man was admitted to the emergency department of our hospital after experiencing a peripheral arterial embolism. Investigation of the possible embolic sources in an otherwise asymptomatic patient revealed the existence of a left ventricular diverticulum. The left ventricular diverticulum is a rare congenital anomaly, either isolated or as a part of a syndrome including other congenital malformations. The treatment of choice, especially in symptomatic patients, is surgical resection, while in asymptomatic patients anticoagulation therapy is indicated.
A 53-year-old woman without any risk factors for coronary artery disease was found to have a congenital intrathoracic left ventricular diverticulum with a narrow long connection to the left ventricular cavity. Coronary angiography revealed normal coronary arteries. The diverticulum was resected and showed three normal cardiac layers. This is an extremely rare finding in the adult population.
Left ventricular diverticulum is a rare congenital anomaly. In the adult population, the incidence was reported to be 0.26% in nonselected patients who underwent cardiac catheterization. Diverticula are usually localized near the apex and most often involve the inferior or anterior parietal walls of the left ventricle. In this report, two cases with congenital left ventricular diverticulum are presented, and the pathophysiologic, diagnostic, and therapeutic approaches of this cardiac malformation are discussed.
The association of left vocal cord paresis with an esophageal diverticulum pointing to the left at the aorto-bronchial level constitutes a syndrome resulting from mediastinal fibrosis in that region. Demonstration of this type of diverticulum in a case of unexplained left cord paresis establishes mediastinal fibrosis as its cause.
Thirteen patients with surgically confirmed Meckel diverticula encountered in a 30 month period are reported. Of 11 symptomatic patients, all had lower gastrointestinal bleeding, except one who had recurrent abdominal pain only. Two diverticula were incidental, coexisting with Crohn disease of the distal ileum. One of these had occasional diarrhea and hematochezia. The diagnosis was established preoperatively by enteroclysis in 11 of these cases. The enterographic demonstration of the mucosal triangular plateau or the triradiate fold pattern indicating the site of exit of the omphalomesenteric duct should lead to a diagnosis of Meckel diverticulum. Pitfalls in interpretation due to the pseudotriangular plateau appearance formed by superimposition of two intestinal loops and the pseudosaccule produced by the axial projection of a fixed loop of bowel and the differential diagnosis are discussed. Enteroclysis seems to be the most dependable method currently available for preoperative demonstration of Meckel diverticulum.
OBJECTIVE: Fifteen patients with female urethral diverticulum (FUD) were referred during nine years. In order to point out the symptomatology and findings and to evaluate the treatment we have reviewed these patients. METHODS: A retrospective analysis of 15 women treated with transvaginal diverticulectomy. The technique is described. RESULTS: The median age was 54 years. All the patients had symptoms of lower urinary tract disorder. The time from the first appearance of symptoms to referral was median 2 years (range, 4 days 30 years). Seventy-five percent of the cases had a pronounced tenderness. In 14 patients a suburethral mass could be found. Purulent material could be expressed in twelve cases. Three patients with symptoms for more than 10 years were characterized by stress incontinence and frequency and recurrent cystitis. No single diagnostic test proved to be specific for FUD. In eight patients (53%) the indication for operation was based only on symptomatology and the presence of a suburethral mass. CONCLUSION: Diverticulum of the urethra is to be suspected in women with unexplained lower urinary tract symptoms. We recommend a collaboration of the two specialties: Gynaecology and Urology.
Two diverticula of the heart that caused no perceptible bulge in the cardiac outline were found at necropsy amongst 197 hearts from patients who had had myocardial infarcts. They lay within the wall of the left ventricle communicating with the left ventricular lumen by a small orifice, had mural thrombus in their lumens, were lined by connective tissue and surrounded by a healing or healed infarct. The lesions resulted from an incomplete rupture of the heart caused by the arrest of a haemorrhagic dissection en route from endocardial to epicardial surfaces through the infarcted ventricular wall. Resorption and organization occurred and a diverticulum formed. The distinct morphology of the diverticulum permits its differentiation from both a left ventricular aneurysm and a pseudoaneurysm.
Tumour development in a bladder diverticulum can cause diagnostic difficulties. We report a case of carcinoma in a diverticulum evaluated by transurethral ultrasonography. Based on the reported case, we would recommend transurethral ultrasonography of the bladder in patients with diverticula and haematuria of unknown cause.
A case is presented in which oesophageal achalasia combined with epiphrenic diverticulum caused severe and progressive symptoms, including gross nutritional disturbance. Resection of the diverticulum and esophagomyotomy gave an excellent result.
The authors present the case of a 22-year-old woman who developed spontaneous intracranial hypotension as a result of a cerebrospinal fluid leak from a thoracic extradural arachnoid diverticulum. The patient was successfully treated by ligation of the diverticulum. The entity of spontaneous intracranial hypotension and its relevance to neurosurgery are discussed.
A 68-yr-old man complaining of sudden, postprandial chest pain visited the emergency room. His symptom had been aggravated during the preceding two days. Upper gastrointestinal contrast study with gastrographin showed leakage of dye from the epiphrenic diverticulum in the lower third of the esophagus. The primary repair was urgently carried out. Upper gastrointestinal contrast study 14 days after operation revealed an esophageal leakage which was small and confined. The patient was managed with conservative treatments such as intravenous hyperalimentation and broad-spectrum antibiotics. Forty-two days after the operation, a gastrographin swallow study showed the absence of leaks. This is the first reported case of a perforated epiphrenic esophageal diverticulum repaired by delayed primary repair in Korea.
Congenital bronchoesophageal fistula is a rare clinical entity in adults. This anomaly may cause various symptoms such as respiratory infections, coughing bouts when eating or drinking, and even hemoptysis. The fistula can cause symptoms in childhood but may not appear until adulthood. We recently experienced a case of congenital bronchoesophageal fistula associated with esophageal diverticulum in an adult. A 63-year-old woman was admitted to our hospital due to chest discomfort, sore throat and coughing bouts when eating. An empyema with lung abscess had occurred eight years previously. Results of the physical examination were unremarkable. A Barium swallowing revealed a medium-sized diverticulum at the right anterior aspect of the esophagus, which had developed a fistulous connection with the right lower lobe bronchus. The patient was treated by fistulectomy and lobectomy of the right lower lobe. The postoperative course was smooth and uneventful.