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PubMedDate not supplied

[Zenker's diverticulum--surgical management in a series of six cases].

Zenker's diverticulum is a protrusion of the posterior mucosal wall of the hypopharynx through the weakened muscular layer, between the oblique fibers of the inferior constrictor of the pharynx and the transverse fibers of the cricopharyngeal muscle (Killian's dehiscence). Pharyngoesophageal pulsion diverticulum is the most common of all the oesophageal diverticuli and is characterised by dysphagia, regurgitation, gurling sounds in the neck and aspiration. The current principles of surgical management includes a pharyngoesophageal myotomy accompanied by a diverticulectomy or a diverticulopexy. The same principles apply in both open approach and the endoscopic methods.

Aged↗
PubMed2005

[Surgery for a pericardial diverticulum; report of a case].

We report a case with pericardial diverticulum in the mediastinum. A 64-year-old woman visited our hospital because of cough and dyspnea. Chest X-ray showed a smooth-bordered mass in the right superior mediastinum and computed tomography (CT) showed a homogeneous cystic mass in the paratracheal area. During right mini-thoracotomy, a thin-walled cystic lesion was found involving the trachea, the superior vena cava, and the azygos vein. The cyst extended a duct toward the pericardium. We performed total excision and pathological examination confirmed the diagnosis of a pericardial diverticulum. Mini-thoracotomy provides an effective and minimally invasive means of excising the mediastinal mass, relieving symptoms, and allowing pathological examination.

Diverticulum↗
PubMed2005

[Dilemmas arising from surgical treatment of epiphrenic diverticulum].

INTRODUCTION: Epiphrenic diverticulum cannot be considered a primary anatomical alteration, there is a manometrically verifiable motility disturbance in the background. OBJECTIVES: To determine the place, type and time of surgical solution in the treatment. PATIENTS: Between 1999 and 2004 seven patients were treated for epiphrenic diverticulum causing complaints. Average age was 61 years, and the leading symptom was dysphagia and regurgitation. Motility abnormalities characteristic of achalasia in four cases, hypertensive LES in three cases, and incompetent and normal LES, and diffuse esophageal spasm in one patient each could be revealed. The size of diverticuli varied between 5-9 cm. RESULTS: In four cases transthoracic diverticulectomy myotomy and partial antireflux plasty, in two cases esophagus resection, and in the case of one patient myotomy and fundoplication was performed. In the removed diverticuli an ulcer and a malignant transformation in one case each was detected. No major complications could be observed. Six patients are completely satisfied with the operation, only one reported well tolerable occasional regurgitations. CONCLUSION: Even in the era of minimal invasive surgery the traditionally performed, combined - diverticulectomy, myotomy, fundoplication - operative solution should be considered the gold standard. Surgical intervention is justified even for accidentally discovered symptomless patients, due to the considerable potential complications of the disease.

Aged↗
PubMed1992

[Disorders of relaxation of the lower esophageal sphincter after resection of mediothoracic esophageal pulsion diverticulum].

A pulsion diverticulum of the mid-thoracic oesophagus was resected because of severe dysphagia. A subdiverticular myotomy was associated for the treatment of non-propagated oesophageal contractions, without oesophageal low-sphincter abnormalities. Three months post-operatively, the dysphagia was still present and manometry showed the absence of lower sphincter relaxation after 45 percent of deglutitions; a lower oesophageal sphincter myotomy was performed, resulting in correction of the dysphagia and of the sphincter relaxation abnormalities. The deficit of the inhibitory nervous mechanism, responsible for abnormalities of lower oesophageal sphincter relaxation, was present in the entire intramural oesophageal plexus, but, was not symptomatic at the level of the IOS prior to resection of the diverticulum.

Diverticulum, Esophageal↗
PubMed1992

[Zenker's diverticulum. The clinical manifestations and treatment].

Clinical manifestations and surgical results are analyzed in a retrospective study of 16 patients with a Zenker's diverticulum. Pharyngoesophageal diverticulum are an uncommon anomaly, producing cervical dysphagia and recurrent airway infections. Treatment should be surgical, as earliest as possible. Morbidity is very low and mortality very rare.

Aged↗
PubMed1992

Zenker's diverticulum and reflux.

The interrelationship between gastroesophageal reflux and Zenker's diverticulum remains unclear. The view that cervical diverticula are induced by gastroesophageal reflux disease (GER) is apparently supported by epidemiologic observations indicating that they occur only in populations with a high incidence of GER. However, it is difficult to prove causality on the basis of currently available physiological and pathophysiological investigations. The few data published to date now end to support a cryptogenic change in upper esophageal sphincter (UES) muscle motility characteristics instead of a reflux induced lesion to the UES. Clinical experience also shows that GER does not play a major role in individual cases of Zenker's diverticula, nor do many surgeons consider it a risk following cervical myotomy. This is confirmed by a very low complication rate even in large series of patients in whom no attempt was made preoperatively to rule out concomitant reflux disease. In conclusion, some facts suggest that reflux disease may be a cause of the development of Zenker's diverticulum. In the majority of cases, however, autochtonic structural lesions to the UES muscle fibers or other, as yet unknown, reasons are more probable.

Adult↗
PubMed1992

Zenker's diverticulum: is a myotomy of the cricopharyngeus useful? How long should it be?

In a series of 100 consecutive patients surgically treated for Zenker's diverticulum (ZD) biopsy specimens were taken at the level of the cricopharyngeal muscle in 62 patients and also at the level of the striated muscle wall of the cervical esophagus in 10 patients. Contractility, pathological enzymo- and immunohistochemical characteristics were studied in comparison with a group of 15 controls. Obvious pathological findings were noted in 95% of the ZD specimens as compared with the control specimens. These pathological changes, although somewhat less pronounced, were also documented in the biopsy specimens taken at the level of the striated cervical muscle wall. The findings were judged important enough to justify a long extramucosal myotomy of the cricopharyngeal muscle and cervical esophagus as an essential step in the treatment of ZD. The treatment of choice in this series was a diverticulopexy and a four to five centimeter long extramucosal myotomy, starting from the cricopharyngeal muscle and extending downwards into the striated muscle wall of the cervical esophagus. Excellent or very good results were obtained in 96% of the patients with respect to diverticulum-related symptoms.

Adult↗
PubMed1992

[An interesting case--endoscopic hemostasis of an actively bleeding sigmoid diverticulum--a case report].

A pulsating arterial bleeding from a diverticulum, situated in the colon sigmoideum, was identified and stopped during video-documentation in a 70 year-old man. After injection with a solution of suprarenin, the diverticulum was turned out like a balloon into the colon and didn't show any signs of further bleeding until the patient was prepared for a semi-elective resection of the sigmoid. This case demonstrates that emergency endoscopy is an effective method for diagnosis and even therapy of massive lower intestinal bleeding which eventually has to be supplemented by radiological techniques like scintigraphy and arteriography.

Aged↗
PubMed2005

[Gangrene of Meckel's diverticulum in strangulated left inguinal hernia].

We report a case of a 57-year-old woman admitted for abdominal pain and a not reducible mass in left inguino-abdominal region. With a diagnosis of strangulated inguinal hernia, the patient underwent urgent surgery. The surgical exploration showed a gangrenous intestinal loop with a Meckel's necrotic diverticulum. A small bowel resection (20 cm) was performed. The post-operative course was uneventful. This seems the first case reported in the literature of woman with a Meckel's diverticulum involved in a strangulated left inguinal hernia.

Female↗
PubMedDate not supplied

[Perforated ulcer in Meckel's diverticulum].

Three cases, two women and one man, aged 27, 47 and 79 years with perforated peptic ulcer of Meckel's diverticulum are reported. All patients had diffuse peritonitis. The exact diagnosis of the cause of peritonitis has not been preoperatively established in any of them. In two patients cuneiform excision (diverticulectomy) was performed, and resection and anastomosis of the small intestine in the third. The female patients, aged 79, after an uneventful recovery suddenly died due to an acute heart failure on the eight day after surgery. In other patient suppuration of the wound occurred and convalescence was prolonged. In all cases microscopic examination revealed ectopic gastric mucosa on the top of the diverticulum with peptic ulcer.

Adult↗
PubMed2006

Symptomatic cesarean scar diverticulum: a case report.

BACKGROUND: Extrauterine lesions of intermediate trophoblast have occurred in and around fallopian tubes and ovaries and are thought to result from an exaggerated trophoblastic response to the implantation site of a previous ectopic pregnancy. Additionally, cesarean scar defects have recently been identified as a source of persistent, irregular vaginal bleeding in women and can be identified by pelvic ultrasound. CASE: A 35-year-old woman presented with irregular vaginal bleeding in association with an anterior extrauterine cystic mass detected by pelvic ultrasound and thought to represent a cesarean scar defect. Subsequent histology revealed an endometrial diverticulum lined with chorionic-type intermediate trophoblast, a subpopulation of trophoblast that composes placental site nodules. CONCLUSION: This was the first case of a lesion of intermediate trophoblast occurring in a cesarean scar diverticulum.

Adult↗
PubMed1991

[Giant diverticulum of the bladder. A case report].

Vesical diverticula are a common pathology of the urinary bladder, generally secondary to cervico-urethral obstruction. Frequency of giant diverticula is not reported in the literature. The Authors present a case of giant vesical diverticulum (20 x 30 cm in diameter) due to prostatic adenoma in which any referable symptomatology was absent. The Authors debate the reasons for which progressive development of the diverticulum has been related with the improvement of the frequency and urgency previously presented by the patient.

Aged↗
PubMed1991

[A choledochal diverticulum. A case report].

Due to the rarity of choledochal cystic dilatation, the authors report a clinical case of common bile duct diverticulum. This diverticulum was histologically composed of gastric ectopic mucosa (pyloric type) and it clinically caused chronic abdominal pain (in a young woman). The authors analyse the literature of the above pathology.

Adult↗
PubMed1991

Surgical treatment of concomitant urethral diverticulum and stress incontinence.

Urinary incontinence is frequently associated with a urethral diverticulum in female patients. Preoperative evaluation including a thorough history and physical examination, voiding cystourethrogram, urethroscopy, and urodynamic studies can diagnose both the urethral diverticulum and any concomitant bladder-urethral dysfunction. Preoperative recognition of stress urinary incontinence or patients at risk for this problem postoperatively permits effective treatment with concomitant transvaginal bladder neck suspension and urethral diverticulectomy.

Diverticulum↗
PubMed1991

Pericardial diverticulum with unusual symptomatology.

A healthy 37 yr old female presented with recurrent right-sided chest pain which spontaneously disappeared. On a chest roentgenogram a lesion in the right cardiophrenic angle was found. Magnetic resonance imaging suggested a cystic structure. During thoracotomy a pericardial diverticulum was found. The pain was probably caused by intermittent volvulus of the diverticulum.

Adult↗
PubMed1991

[A case of successful surgical repair for congenital corrected transposition of the great arteries associated with Ebstein's malformation and diverticulum of atrialized ventricle].

Congenital corrected transposition of the great arteries (C-TGA) is frequently associated with VSD and PS. Systemic atrioventricular valve regurgitation is also sometimes present in patients with C-TGA. It is though that left-sided A-V valve regurgitation is caused by the deformities of the tricuspid valve (TV) or intolerance of TV and the right ventricle (RV) against systemic pressure load. We had a patient with C-TGA associated with Ebstein's malformation. The patient suffered from congestive heart failure due to left-sided A-V valve regurgitation. In this case, the septal and posterior leaflets were displaced below the atrioventricular annulus. The edges of all valves were thickened and partially calcified. Focal agenesis was found in the septal leaflet. There was a distinct atrialized ventricle which had a thin wall and no trabeculae. It shaped like a diverticulum of 3 cm in depth toward the diaphragm. Preoperative cardiac catheterization showed that the functional RV had an adequate size (RVEDVI 162% of normal) and ejection fraction was 53%. Left-sided valve replacement was performed using SJM 31M with preservation of TV. Left-sided atrioventricular annulus was so deformed due to the diverticulum that the prosthetic valve was sutured at the ventricular wall below the atrioventricular annulus to which TV had attached. Good clinical result was obtained after surgical treatment.

Diverticulum↗
PubMed1990

[Meckel's diverticulum: the usefulness of 99m Tc pertechnetate scintigraphy].

The paper discusses the utility and appropriateness of instrumental tests (in particular scintigraphic detection) which are regularly used for the preoperative diagnosis of Meckel's diverticulum. The case is reported of a 9-month-old infant affected by severe recidivating attacks of melena in whom the diagnosis of Meckel's diverticulum was delayed by the repeated negativity of instrumental tests.

Humans↗
PubMed1990

[Aneurysm of the diverticulum of the ductus arteriosus in the adult].

Aneurysm of the diverticulum of the ductus arteriosus is a rarely reported entry in adult. To our knowledge, only two previous patients underwent successful aneurysmectomy in Japan. Three new cases of aneurysm of the ductus arteriosus diverticulum in the adult, all diagnosed preoperatively and successfully repaired, are presented. All three patients are alive 17 to 44 months postoperatively. Our experience with these patients suggests several important features of these aneurysms: (1) CT scanning with contrast enhancement will almost invariably confirm the diagnosis of these aneurysms. (2) Exposure through a median sternotomy is generally good and carries less operative morbidity from rupture than a posterolateral thoracotomy. (3) Because of their critical location and the high incidence of rupture in reported cases, aneurysms producing symptoms, or those showing progressive enlargement should be surgically resected. (4) When a succular aneurysm of the aortic arch is demonstrated expanding toward the aortopulmonary window with adhesion to the pulmonary artery, the possibility of its origin from the ductus arteriosus must be investigated.

Age Factors↗