A case of leiomyosarcoma of Meckel's diverticulum

The authors report a case of mesenchymal tumor (leiomyosarcoma) arising in a Meckel's diverticulum, with an history of digestive bleeding. Different kinds of Meckel's diverticulum tumors, their symptomatology and diagnostic difficulties are then discussed.     

A new technical approach for extraperitoneal laparoscopic bladder diverticulectomy

In this paper, the authors report on a new, modified laparoscopic technique to remove a large bladder diverticulum. A 26-year-old male with a urinary problem underwent an ultrasound, as well as intravenous urography and cystoscopy examinations, which showed a large bladder diverticulum. The diverticulum was operated upon laparoscopically. The extraperitoneal laparoscopic intervention was facilitated by balloon placed into the diverticulum. The new technique for the laparoscopic diverticulumectomy procedure was successful and the operating time was 140 minutes. There were no perioperative complications. In conclusion, the laparoscopic removal of the bladder diverticulum is a safe and minimally invasive intervention. The introduction of a balloon into the diverticulum makes the operation easier.     

Subcardial stomach diverticulum and gastroesophageal reflux]

Gastric diverticulum is a rare disease, often benign and specifically located in the right paracardial region. The authors report a case of left paracardial diverticulum with gastro-oesophageal reflux. This association should be treated surgically with resection of the diverticulum, after failure of medical treatment.     

Meckel's diverticulum: report of two cases and review of the literature

Meckel's diverticulum is considered the most common diverticulum of the small intestine. Of the various complications associated with this condition, intestinal obstruction is one of the most common. Rapid diagnosis and treatment are essential. Resection of the obstructing element is the treatment of choice. The authors report on their recent experience with two patients with Meckel's diverticulum, both of whom had intestinal obstruction as the presenting complication. The authors discuss the etiology and various complications of Meckel's diverticulum and present information on the frequency of associated mortality and morbidity.     

Meckel's diverticulum masked by a long period of gastric symptoms--a case report

Meckel's diverticulum (MD) is the most frequent congenital abnormality of the small bowel and it is often difficult to diagnose. The authors report a case of a patient with long-term symptoms erroneously not related with MD disease and developing a diverticulum perforation.     

Scrotal pseudoabscess revealing congenital diverticulum of the anterior urethra in children]

The authors report a case of infected congenital diverticulum of the anterior urethra in a 6-week-old infant. This diverticulum presented clinically in the form of a scrotal abscess. Retrograde cystourethrography established the diagnosis. Two-stage treatment was preferred because of the infection: aspiration of the diverticulum and antibiotics, subsequently followed by surgical repair with resection of the diverticulum and immediate urethral reconstruction. The immediate postoperative course was marked by demonstration of hypertrophic pylori stenosis, which had not been previously investigated despite the presence of symptoms predating the diverticulum (repeated vomiting at the age of one month). Treatment was surgical. A brief review of diverticula of the anterior urethra is presented, defining the aetiological factors as well as the diagnostic and therapeutic features.     

Treatment procedure in complicated duodenal diverticula

The authors share their experience with the treatment of 18 patients. Most of them (10) sought medical aid for complications. The authors consider resection of the stomach to be ineffective for the exclusion of the diverticulum of the duodenum. The operation of choice is thought by them to be an exclusion of the duodenum from the passage of food. Stomach resection after Ridiger is thought to be effective for a combination of the diverticulum and duodenal ulcer. There were no complications or immediate lethal outcomes.     

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.     

Pharyngoesophageal diverticulum following cervical corpectomy and plating. Case report

This case of a pharyngoesophageal diverticulum was diagnosed 3 years after a corpectomy and fusion for a cervical fracture. The diverticulum was excised, the plate and screws were removed, and the patient was asymptomatic 3 years later. The dense scar tissue around the hardware probably caused traction on the posterior pharyngoesophageal region, followed by development of the diverticulum. The authors speculate that the malpositioning of the hardware was an irritative factor promoting such a scar. To the best of their knowledge, this is the first reported case of pharyngoesophageal diverticulum following cervical corpectomy and plating.     

Congenital ureteral diverticulum coexistent with hydronephrosis caused by vascular compression involving the uterine artery and umbilical ligament: report of a case

Coexistence of congenital ureteral diverticulum and hydronephrosis caused by vascular compression is a rare entity. The authors experienced a case of congenital ureteral diverticulum coexistent with hydronephrosis caused by aberrant vascular compression by uterine and umbilical arteries in a 14-year-old girl. The authors could not diagnose accurately this abnormality preoperatively by 3-dimensional computed tomography. After partial ureterectomy, including resection of the saccular lesion and ureteroneocystostomy, the frequency of urinary tract infection decreased.     

Percutaneous management of caliceal diverticula

The diagnosis of a caliceal diverticulum may be serendipitous or established owing to patient symptoms. Once the decision to treat a diverticulum has been made, a percutaneous approach should be considered. If stones are present, complete stone removal and obliteration of the diverticulum should be the goals of surgery. The authors prefer the direct puncture technique whenever possible to limit the risk for bleeding and to facilitate stone removal. Use of a percutaneous approach in properly selected patients affords high success rates and results in few complications.     

Zenker's diverticulum. Apropos a case

The authors report a case of Zenker's diverticulum in a patient 72 years old who underwent surgery. The pharyngoesophageal function was investigated before and after cricopharyngeal myotomy and diverticulopexy, with oesophageal manometry. Preoperative manometry showed an incomplete relaxation of the upper oesophageal sphincter and increased of pharyngeal pressure. This diverticulum has a pulsion pathogenesis and in this case is not associated with gastroesophageal reflux. It is important to check whether an associated oesophageal pathology exist once Zenker's diverticulum has been diagnosed: X-ray examination of oesophagus and stomach are capable of identifying the presence of diverticulum as well as other pathological association. In the case showed the clinical manifestation are represented by: cervical dysphagia, sensation of foreign body while eating due to the accumulation of ingested food in the diverticulum, and noisy deglutition. The surgical treatment in this case consist of diverticulopexy with cricopharyngeal myotomy. This case is treated with diverticulopexy for two reason: because is not very big and to reduce post-operative period. In conclusion the authors shows the importance of this surgery for not very large sized pouches, and emphasise the importance of manometric and radiographic control in pre and post-operative period. This kind of surgery reduce post-operative complication and the period to stay in bed.     

Perforated jejuneal diverticulosis. Case report and review of literature

Acquired (non-Meckel's) jejunoileal diverticulosis is an uncommon disease, generally characterised by vague and unspecific symptoms. This rare condition is mainly expressed as acute complications: gastrointestinal haemorrhage, mechanic obstruction of the small intestine or perforated diverticulum, requiring urgent surgical intervention. The authors report a case of this unusual clinical occurrence characterized by a picture of abdominal pain due to perforation of jejuneal diverticulum. The final etiological diagnosis was possible only during surgery.     

Zenker's diverticulum]

An experience with treatment of 14 women and 15 men aged from 41 to 83 years with Zenker's diverticulum was analyzed. Most liable to the disease were people at the age from 50 to 70 years. The average duration of the disease was 3-4 years. All the patients were subjected to improved surgical interventions: resection of the diverticulum (11 patients), operations under the control of the endoscopic technique (18 patients). Resections of the diverticulum were combined with cryopharyngeal myotomy. No complications were noted. There were no lethal outcomes. So, wider indications to operative treatment in patients with Zenker's diverticulum, endoscopic methods used at all stages of treatment as well as improved methods of performing the operation enabled the authors to obtain good immediate and long-term results.     

Symptomatic anterior spinal arachnoid diverticulum

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's diverticulum perforation with intraabdominal hemorrhage

Perforation of Meckel's diverticulum in children is a rare and serious complication. The authors report a case of a 3-year-old boy with perforation and hemoperitoneum caused by Meckel's diverticulum. Difficulty of preoperative diagnosis is discussed, indication for incidental diverticulotomy is established, and the literature is reviewed. J Pediatr Surg 37:E18.     

Urethral diverticulum with multiple calculi with presentation of urinary incontinence in a female — A case report and literature review

Urethral diverticulum with multiple calculi is a rare condition that is often difficult to diagnose. We present a 46-year-old female with initial symptoms of stress urinary incontinence and subconscious urine leakage. Magnetic resonance imaging revealed a large diverticulum with multiple stones in it. Transvaginal repair of the urethral diverticulum was performed. Some authors and textbooks suggest concomitant anti-incontinence surgery in patients with a similar condition, but we did not do so under the considerations of patient autonomy and risk of infection. The incontinence subsided spontaneously after diverticulectomy alone, against our expectations.     

Laparoscopic resection of gastric diverticulum

Gastric diverticulum is a rare disorder. The laparoscopic approach may be ideal for the resection of gastric diverticulum in some cases. The authors believe this to be the first reported case of gastric diverticulum resected laparoscopically. A 59-year-old woman was admitted with indigestion and epigastric pain. Upper gastrointestinal series showed a single diverticulum (3 x 2 cm) on the posterior wall of the upper part of the stomach. The neck of the diverticulum was relatively narrow. Gastroduodenoscopy revealed that food residues were impacted within the diverticular pouch. Other areas of the stomach and the duodenum were normal. Abdominal ultrasonography showed no other pathologic conditions in the upper part of abdomen. On operation, the lesser sac was entered by division of the greater omentum along the avascular plane of the transverse colonic attachment. The location of the diverticulum was confirmed by intraoperative gastroscopy. Using a 5-cannula techniques, the diverticulum was resected with an endoscopic linear stapler device. Pathologic examination of the resected specimen demonstrated chronic superficial gastritis. Flatus was passed out on the first postoperative day, diet was started from the second day, and the patient was discharged on the fifth day without problems.     

Operative treatment and diagnostics of Zenker diverticulum using modern endoscopic technique

The authors present results of examination and treatment of 272 patients with Zenker diverticulums of different localization. Features and problems in fibroesophagoscopy in patients with Zenker diverticulum are discussed. Surgical interventions with endoscopic assistance were fulfilled in 37 patients with diverticulum. A new way of endoscopic management of Zenker diverticulum using preparation "Disport" and the method of endoscopic incision of cricofaringeal muscle are proposed. Good clinical results of the treatment were obtained.