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PubMed2005

Isolated rectal diverticulum complicating with rectal prolapse and outlet obstruction: case report.

The occurrence of rectal diverticula is very rare, with only sporadic reports in the literature since 1911. Symptomatic rectal diverticula are encountered even less frequently. Treatments of these complicated events range from conservative treatments to major surgical interventions. We present a hitherto unreported occurrence of isolated rectal diverticulum complicated with rectal prolapse and outlet obstruction. Delorme's procedure resulted in subsidence of symptoms and resolution of the diverticulum. It provides a minimal invasive surgical technique to successfully address the reported malady.

Aged↗
PubMed2002

Pharyngoesophageal (Zenker's) diverticulum: case report.

Pharyngoesophageal pulsion diverticulum is the most common of all oesophageal diverticuli and is characterised by dysphagia, regurgitation, gurgling sounds in the neck and aspiration. This is a report of an 80-year old female who presented with progressive dysphagia, weight loss and recurrent bouts of pneumonitis. A barium swallow showed a pharyngoesophageal diverticulum and an upper endoscopy confirmed a wide ostium and no other pathology. She underwent surgical pharyngoesophageal diverticulectomy and cricopharyngeal myotomy under general anaesthesia and made complete recovery with total relief of dysphagia.

Aged↗
PubMed2005

[Urodynamics of the bladder diverticulum in the adult male].

OBJECTIVES: To evaluate the clinical and urodynamic characteristics of a series of adult males with BPH and bladder diverticula, and to analyze the changes in urodynamics in patients undergoing lower urinary tract surgery to relieve obstruction, with or without associated diverticulectomy. METHODS: We studied 91 patients in two groups: Group 1- BPH: 67 cases (73.6%) and Group 2-BPH + diverticulum: 24 cases (25%). Mean age was 65.04 years. All patients underwent urological physical examination and complete urodynamic study including cystogram. In addition, we studied 19 patients with BPH and bladder diverticula (mean age 64.58 years) who underwent either endoscopic surgery (1 I cases; 57.9%) or endoscopic surgery plus diverticulectomy (8 cases, 42. 1%). Complete clinical study and urodynamics (including cystogram) were performed preoperative and three months after surgery. Statistical significance was established at 0.05. RESULTS: Comparative study between group 1 (BPH) and group 2 (BPH with diverticulum): there were significant differences in clinical data: acute urinary retention (6.1% vs. 25%;p<0.01), and urinary tract infection (3.1% vs. 21.7%;p=0,004). All evaluated cases had single diverticula (8 cases). Urodynamic studies showed: 1) Post-void residual after free flowmetry: 45.9 ml vs. 221.4 ml, p = 0.008. 2) Bladder capacity on cystometrogram: 211.2 ml vs. 350.8 ml, p = 0.024. 3) Voiding pressure/flow study: a) Voiding with abdominal press 23.9% vs. 50%, p = 0.02. b) URA 36.5 cm H2O vs. 48.5 cm H2O, p= 0.04, c) post void residual 70.7ml vs. 210.3 ml, p= 0.004. d) Bladder contractility measurements (Wmax- isometric contractility- and W80, W20- isotonic contractility) did not show significant differences between groups. Bladder contractility duration was significantly decreased in group 2. In the analysis of patients undergoing surgery to relieve obstruction (Group A- Surgery without diverticulectomy; Group B Surgery with diverticulectomy) there were not differences between groups in clinical data. Urethral resistance parameters (URA) decreased in both groups. Group A: from 43 cm H20 to 26.3 cm H2O. Group B: from 60.6 cm H2O to 48 cm H2O. This decrease was similar after either TURP or myocapsulotomy. Post void residual diminished in both groups. There were no statistical differences between groups in Wmax, W 80-20, or volume, number and site of the diverticula. On the contrary, bladder contractility duration diminished after diverticulectomy. CONCLUSIONS: Bladder diverticula appear in the cases with highest ureteral resistance values (lower urinary tract obstruction). Standard bladder contractility parameters were not diminished. Duration of detrusor contraction was the only contractility parameter significantly affected in cases of bladder diverticula and presented a significant association with the use of abdominal press while voiding. Diverticulectomy showed an improvement of bladder contractility with longer detrusor contraction duration, which supports its use in cases of BPH-associated diverticula. Both TURP and transurethral incision of the prostate diminished urethral resistance in a similar way, so that they may be considered alternative options. Our data should be confirmed with a bigger sample size.

Aged↗
PubMed2006

20 years experience in the management of Zenker's diverticulum in a third-level hospital.

Zenker s diverticulum arises in the posterior wall of the pharynx, above the cricopharyngeal muscle, secondary to a functional cricopharyngeal disorder. We describe our experience with the management of Zenker s diverticulum from 1985 to this day in a third-level hospital. We review clinical data from 27 patients (78% males) with a mean age of 60.4 years. The most common clinical manifestations were dysphagia, regurgitation, syalorrhea, cough, and weight loss. All cases were diagnosed using an esophagogram. A diverticulectomy with cricopharingeal myotomy was performed in 74% of patients. Complications developed in 5 cases (21%), and the recurrence rate was 4% (1 of 3 cases, where myotomy was not performed).

Adult↗
PubMed2006

Inflammation and perforation of a solitary diverticulum of the cecum. A report of 5 cases and literature review.

Solitary diverticulum of the cecum is a benign condition uncommon in the Western world, and with a higher incidence in Asian population. They are usually asymptomatic, and manifest clinically only with complications such as inflammation, perforation, or bleeding. They are a rare cause of acute abdominal pain, clinically similar to acute appendicitis, with tenderness in the right lower quadrant, fever, and leukocytosis. In spite of the information provided by ultrasonography or CT scans, a correct preoperative diagnosis is still difficult to reach, and is usually arrived at in the operating theater; differentiation from a neoplasm may be also sometimes complicated, and a wide surgical resection is usually required for such cases. We report on 5 cases of inflammation and perforation of a solitary cecal diverticulum, and perform a literature review.

Adult↗
PubMed1984

Solitary diverticulum of the caecal area.

Two cases of acute inflammation of a solitary diverticulum of the caecal area are reported, which illustrate the unusual, but well documented, problems that may arise in this condition. The first patient presented with clinical symptoms and signs of acute appendicitis, but the operative findings suggested carcinoma of the caecum. The second patient presented with pyrexia of unknown origin, and the preoperative diagnosis was that of cholangitis. The treatment by right hemicolectomy was successful in both cases, and this operation is recommended for patients who present with a complication of a solitary diverticulum in the caecal area.

Aged↗
PubMed1986

Leiomyoma of Meckel's diverticulum.

Meckel's diverticulum is a common developmental abnormality of the midgut which may present clinically because of complications. This report describes an unusual clinical presentation of a patient with a large leiomyoma of a Meckel's diverticulum.

Adolescent↗
PubMed2000

[Two cases of primary carcinoma developed in a vesical diverticulum treated with ileal neobladder for total bladder replacement].

Two cases of carcinoma developed in vesical diverticulum were encountered. Both these males, the first, 66-year-old and the second case, 68-year-old gentleman, visited our clinic with a complaint of asymptomatic gross hematuria. Total cystectomy was performed, and an ileal neobladder was constructed for total bladder replacement in both two cases. Pathological examination of the first case revealed transitional cell carcinoma, and the second case showed adenocarcinoma mixed with transitional cell carcinoma. Although primary carcinoma developed in vesical diverticulum was initially reported by Williams in 1883, adenocarcinoma is very rare. The diagnosis is often challenging and the prognosis is dire. Both our cases were successfully treated with total cystectomy and an ileal neobladder was constructed for total bladder replacement. Careful management and aggressive therapy for such patients may make even cure possible.

Adenocarcinoma↗
PubMed2005

[A case of true ureteral diverticulum].

A 31-year-old man was presented with an asymptomatic repeated gross hematuria. A drip infusion pyelography (DIP) revealed a pouch with a stone in the left lower ureter. 29 months later, he was re-hospitalized for left flank pain. Urinalysis revealed 10 to 19 RBC and 20-29 WBC/HPF. A DIP demonstrated left mild hydronephrosis due to the ureteral stenosis just proximal to the stone filled-ureteral pouch. He underwent partial ureterectomy. Histologic examination revealed the true ureteral diverticulum with all the layers of a ureteral wall. True ureteral diverticulum is a rare congenital anomaly. To our knowledge, this is the 3rd case in the Japanese literature.

Adult↗
PubMedDate not supplied

[Tracheal diverticulum after surgical correction of esophageal atresia. 2 cases].

Two newborns with congenital oesophageal atresia (Gross type III) were successfully operated on during the neonatal period. The occurrence, several months later, of chronic cough, associated in one infant with impaired pulmonary ventilation, lead to the discovery of a tracheal diverticulum, on the pathway of the primitive tracheo-esophageal fistula. Surgical excision of the diverticulum was followed by complete recovery.

Cough↗
PubMed1999

[Experience with surgery for congenital esophago-bronchial fistula with esophageal diverticulum in adult].

A 65-year-old female was admitted into our department with complaint of bloody sputum. An upper G-I series examinations and thoracic CT demonstrated an esophago-bronchial fistula with diverticulum located between the mid-esophagus and right B6. Following postero-lateral thoracostomy, the fistula was surgically removed and right lower lobectomy was carried out. No inflammatory changes were found in the surrounding tissues of the fistula and the diverticulum. Histological examination revealed that the fistula wall contained squamous epithelium and muscularis mucosa. These results suggested that this case was congenital esophago-bronchial fistula categorized as Braimbridge type I.

Aged↗
PubMed1998

[Giant diverticulum of the duodenum. Case report].

The authors describe the case of a 49-year-old man with a giant diverticulum of the duodenum, with apparently scarce symptoms, pointed out by gastroscopy and X-ray of the upper gastrointestinal duct with barium meal. The removal of the lesion, obtained after surgical operation, showed a diverticulum with a 6 cm diameter, with signs of diverticulitis; the histological test did not point out is degenerative lesions. A survey of the recent literature on the matter is presented.

Diverticulum↗
PubMedDate not supplied

[Intraluminal duodenal diverticulum (author's transl)].

The authors report a case of intraluminal duodenal diverticulum and compare it with those reported previously in the literature. They emphasise the diagnostic methods, the pathological characteristics and consider the proper identification of the papilla of the ampulla of Vater very important since this structure is often adjacent to the diverticulum.

Adult↗
PubMed1999

[Intermittent obstructive jaundice as a form of presentation of duodenal diverticulum].

We report the case of a previously well 89-years-old-healthy man who presented at least four episodes of intermittent obstructive jaundice during the eight months prior to admission in our Hospital. Studies revealed a duodenal diverticulum arising near of the ampulla of Vater. We believed the diverticulum was responsible for the intermittent obstructive jaundice and we performed a choledochoduodenostomy. He had no postoperative complications and was discharged from the hospital asymptomatic. This case documents an uncommon presentation of this disease generally asymptomatic with intermittent obstructive jaundice episodes.

Aged↗
PubMedDate not supplied

Seldom found acute abdomen: perforated diverticulum in the transverse colon.

The authors report a recently examined rare case of isolated perforated diverticulum of the transverse colon. At surgery, a perforated omentum-sealed diverticulum was found in the third distal wall of the transverse colon. A diverticulectomy was performed. The postoperative course was excellent.

Abdomen, Acute↗
PubMed1999

Urethral diverticulum presenting with chronic pelvic pain: a case report.

Urethral diverticula are rarely encountered in the gynecologic out-patient setting. However, this condition probably occurs more frequently than it is diagnosed. The patient frequently notes signs of lower urinary tract irritation. Urinary dribbling accompanied with dyspareunia and dysuria constitutes a classic triad for urethral diverticula. Symptoms of chronic pelvic pain only occur in a minority of patients. We report a case of urethral diverticulum presenting chiefly with chronic pelvic pain. The patient underwent multiple investigative operations before a correct diagnosis was made. When confronted with a patient presenting with chronic pelvic pain, a gynecologist should retain a high index of suspicion for a urethral diverticulum in addition to other gynecologic conditions.

Chronic Disease↗
PubMed1999

[The epiphrenic esophageal diverticulum. Its transhiatal laparoscopic treatment].

A new laparoscopic surgical approach to treat an esophageal epiphrenic diverticulum is described. This is a rare disease. Today only 4 cases of laparoscopic transhiatal treatment with good results are reported in the literature. The present case report is an 80 years-old male with medium size epiphrenic diverticulum (10 cm) and very symptomatic dysphagia. Preoperative investigations include barium swallow, upper gastrointestinal endoscopy and esophageal manometry. The laparoscopic transhiatal treatment was carried out without difficulty. Diverticulectomy esophageal myotomy and partial gastric fundoplication (Dor) were performed. No postoperative complication was recorded and optimal result was achieved. In conclusion, the efficacy of laparoscopic approach is underlined and the short and medium-term results are satisfactory.

Aged↗
PubMed2000

Meckel's diverticulum.

Although Meckel's diverticulum is the most prevalent congenital abnormality of the gastrointestinal tract, it is often difficult to diagnose. It may remain completely asymptomatic, or it may mimic such disorders as Crohn's disease, appendicitis and peptic ulcer disease. Ectopic tissue, found in approximately 50 percent of cases, consists of gastric tissue in 60 to 85 percent of cases and pancreatic tissue in 5 to 16 percent. The diagnosis of Meckel's diverticulum should be considered in patients with unexplained abdominal pain, nausea and vomiting, or intestinal bleeding. Major complications include bleeding, obstruction, intussusception, diverticulitis and perforation. The most useful method of diagnosis is with a technetium-99m pertechnetate scan, which is dependent on uptake of the isotope in heterotopic tissue. Management is by surgical resection.

Female↗