Female urethral diverticulum calculi: a case report

A case of urethral diverticulum with calculus in a 53-year-old woman is reported. She was admitted to Isahaya General Hospital complaining of a localized swelling in the external genitalia. We found a urethral diverticular calculi by urethrography. Urethral diverticulectomy was carried out without any complications. The removed stones were in 2 pieces and they were composed of calcium phosphate and ammonium urate.     

A case of infected caliceal diverticulum]

A 60-year-old woman was admitted to our clinic with the chief complaint of high fever. Antibiotic therapy had produced no improvement in another hospital and she was referred to our hospital for further examination and treatment. Intravenous pyelography showed left non visualized kidney and a stone shadow in left ureter. Computed tomography showed a cystic lesion, 9 x 9 x 8 cm, in the upper pole of the left kidney. We punctured and drained 400 cc of turbid yellowish fluid by a transcutaneous route. The nephrostogram clearly showed a communication with infundibulum. A diagnosis of infected caliceal diverticulum was made. Further examination demonstrated no function of left kidney and we performed nephrectomy. She has reported no symptoms for 6 months after the operation.     

Esophago-pharyngeal diverticulum: a case report

The Authors report a case of Zenker's diverticulum seen and treated at the University Department of Surgical Sciences of the University of Foggia. The treatment of this condition is invariably surgical and consists in a diverticulectomy combined with a lengthwise extramucosal myotomy. This latter technical adjunct, however, would not appear to be accepted by all Authors. Other techniques have been proposed for the treatment of this condition, but no confirmation of their efficacy exists in the literature. Mortality fluctuates in the various case series, from 0.45% to 8.1%, and the morbidity varies from 5.3% to 40%. The risk of postoperative complications is always present, but can be reduced if the patient undergoes a thorough preoperative investigation.     

A case report: Cecal volvulus caused by Meckel's diverticulum

INTRODUCTION

Meckel''s diverticulum is the most common congenital anomaly of the small intestine. Common complications related to Meckel''s diverticulum include hemorrhage, intestinal obstruction and inflammation. Acute large bowel obstruction is a rare complication of Meckel''s diverticulum and in the presented case it is caused by volvulus.

PRESENTATION OF CASE

We report a 39 year old female who presented with the diagnosis of a large bowel obstruction occurring as a result of cecal volvulus caused by adhesions of a perforated diverticulum.

DISCUSSION

The reported case presents one of the rare complications of MD, which is volvulus. The case described above presented with signs and symptoms suggestive of acute intestinal obstruction and radiological findings suggestive of cecal volvulus. The patient was taken to the operation room for exploration and we discovered the presence of a perforated MD. The main treatment of such case is to perform diverticulectomy in all symptomatic patients.

CONCLUSION

MD is mostly identified intraoperatively. Knowledge of the pathophysiologies by which MD can cause complications such as volvulus is important in order to plan management.     

Preputial calculi: a case report

The patient was a 92-year-old male whose chief complaint was urinary retention. The X-ray film showed multiple overlapping calcification shadows in the penile region. Renal insufficiency was speculated to be due to post-renal obstruction. Under the diagnoses of closure of the preputial orifice by balanoposthitis followed by urinary retention and preputial calculi, an urgent dorsal incision of the prepuce was made. Then, stone removal and indwelling catheter placement were performed. Renal function recovered soon after the operation, and the patient could urinate freely without catheterization. This case reminds us of the significance of surgical treatment for phimosis in elderly patients.     

Stone-containing pyelocaliceal diverticulum: a case report

We report a case of stone-containing pyelocaliceal diverticulum. A 68-year-old man was admitted for extensive investigation of microscopic hematuria on January 12, 1983. A cluster of numerous small calcifications was disclosed in the left renal region on an abdominal plain film and the case was considered to be of stones in the left kidney. An excretory pyelogram showed that the stones were away from the collecting system of the left kidney. Through partial nephrectomy, 107 stones were removed on January 21, 1983. Histological examination of the surgical specimen revealed pyelocaliceal diverticulum. The stones were found to consist of calcium oxalate and calcium phosphate by infrared spectrophotometry. In addition to these components, a small amount of magnesium was detected by X-ray microanalysis. A scanning electron microscopic study of the cut surface of the stones disclosed the presence of a granular core identified as urate and calcium oxalate, concentric laminations of crystallized substances in the mid-zone and laminations of amorphous substances in the outer layer.     

Giant vesical diverticulum: a case report

A case of giant vesical diverticulum is reported. A 31-year-old man was admitted with intermittent self-catheterization for 6 months duration due to urinary retention. A cystogram demonstrated a giant solitary diverticulum extended left-posteriorly, which compressed the bladder outlet and caused obstruction. On cystoscopy, the neck of the diverticulum was seen postero-lateral to left ureteral orifice. There was no vesical trabeculation, but slight obstruction of the bladder neck was suspected secondary to intermittent self-catheterization. A diverticulectomy was carried out by combined approach without ureterocystoneostomy. The patient had no difficulty in voiding after the operation.     

Percutaneous ablation of caliceal diverticulum: long-term followup

PURPOSE: A caliceal diverticulum is a nonsecretory cavity that serves as a conduit for urinary stasis and its ensuing complications. Indications for intervention and modes of therapy are controversial. We report a series of patients treated with a percutaneous endourological approach to ablation of the diverticular cavity. MATERIALS AND METHODS: A total of 14 patients underwent percutaneous ablation of a caliceal diverticulum for flank pain a mean of 15.5 months in duration. These caliceal diverticula were associated with urinary tract infection in 43% of cases and/or renal calculi in 78%. Mean calculus diameter was 10.2 mm. and mean diverticular diameter was 10.9 mm. An open ended ureteral catheter was placed into the renal pelvis via cystoscopy. Retrograde instillation of radiopaque contrast medium facilitated the localization of a percutaneous renal puncture made directly into the caliceal diverticulum. A flexible tip guide wire was coiled in the diverticulum, and no effort was made to traverse the infundibulum and establish continuity with the remainder of the collecting system. Tract dilation into the caliceal diverticulum was performed, and percutaneous stone fragmentation and extraction were accomplished. The lining of the caliceal diverticulum was electrocauterized using a roller ball electrode. A balloon nephrostomy tube consisting of a Foley catheter with the tip cut off was positioned into the diverticulum. An indwelling ureteral stent was placed and a Foley catheter provided bladder drainage for 48 hours to maintain a low pressure system. The nephrostomy tube was removed after 24 to 48 hours and the ureteral stent was removed after 2 to 4 weeks. RESULTS: Mean operative time was 162 minutes and mean hospital stay was 2.3 days. Obliteration of the diverticular infundibulum and cavity was documented by contrast radiography (excretory urography or retrograde pyelography), and noncontrast and contrast enhanced computerized tomography, respectively, in all 14 patients. No patients have had recurrent symptoms, calculi or urinary tract infection at a mean 38-month followup. CONCLUSIONS: Percutaneous electrocautery ablation of caliceal diverticula without cannulation or dilation of the diverticular infundibulum represents a safe and effective mode of therapy. Careful patient selection and preparation optimize the efficacy of this technique.     

Perforated duodenal diverticulum: report of a case

After the colon, the duodenum is the most common site of diverticula. Duodenal diverticula can be divided into two types: intraluminal or extraluminal. The latter are more frequent, with a prevalence ranging from 0.6 to 27% in relation to the diagnostic methods utilized. Females are more often affected than males. About 70-75% of extraluminal duodenal diverticula are located in a circular area centred around the ampulla of Vater within a radius of 2-3 cm; these are defined as periampullary or juxtapapillary. Perforation is the rarest type of complication and can simulate different clinical conditions. CT plays a fundamental role in diagnosis also in relation to the different diverticular topography. Perforation is an indication for emergency surgery. The authors describe the clinical case of a duodenal diverticulum containing the outlet of the papilla, complicated by perforation; CT showed retroduodenal fluid and free air. Emergency surgery with an external biliary drainage, naso-biliary probe, and a diverticulo-jejunostomy on a Roux-en-Y defunctionalised loop, resolved the condition.     

Staghorn silicate calculi: a case report

A 71-year-old woman complaining of fever and left flank pain was referred to our hospital. She had no history of taking any silicate-containing antiacids. She was diagnosed with left staghorn renal stone and repeated extracorporeal shock wave lithotripsy was performed. Analysis of the stones revealed silica calculi. Forty-nine cases of silica calculi have been reported in Japan, but this is the first case of nearly pure staghorn silicate calculi.     

A case of female urethral diverticulum calculi

A 53-year-old nulliparous woman complained of terminal pain on urination and bended micturition. Previously, she had been treated unsuccessfully with antibiotics for chronic cystitis. On examination, a mass of approximately a thumb's head-size, was palpated at the left portion of urethral meatus. Plain film of the pelvis revealed stones under the margin of symphysis pubis. Positive pressure urethrography revealed a diverticulum slightly larger than the stones. Transvestibular diverticulectomy and urethrolithotomy were performed without any postoperative complications. In Japan, 38 cases of diverticulum calculi of the female urethra have been reported.     

Silica calculi: a case report]

A 66-year-old female visited our university hospital with the chief complaint of right lower abdominal pain in July, 1984. Kidney-ureter-bladder roentgenograms disclosed the right ureter stone and several left renal stones. She passed the right ureter stone composed of calcium oxalate. Thereafter, she passed small stones twice and sand stones twice until September, 1985. The stone analysis revealed two of them as silica. Although most patients with silica stones reported in Japan had a history of long-term medication of magnesium trisilicate, this patient had not taken this drug. Silica stones are rare and fifteen cases including the present case have been reported in Japan.     

Torsion of Meckel's diverticulum as a cause of small bowel obstruction: A case report

Axial torsion and necrosis of Meckel's diverticulum causing simultaneous mechanical small bowel obstruc-tion are the rarest complications of this congenital anomaly. This kind of pathology has been reported only eleven times. Our case report presents this very unusual case of Meckel's diverticulum. A 41-year-old man presented at the emergency department with complaints of crampy abdominal pain, nausea and re-tention of stool and gases. Clinical diagnosis was small bowel obstruction. Because the origin of obstruction was unknown, computer tomography was indicated. Computed tomography(CT)-scan revealed dilated small bowel loops with multiple air-fluid levels; the oral con-trast medium had reached the jejunum and proximal parts of the ileum but not the distal small bowel loops or the large bowel; in the right mid-abdomen there was a 11 cm × 6.4 cm × 7.8 cm fluid containing cavity with thickened wall, which was considered a dilated bowel-loop or cyst or diverticulum. Initially the patient was treated conservatively. Because of persistent abdominal pain emergency laparotomy was indicated. Abdominal exploration revealed distended small bowel loops proxi-mal to the obstruction, and a large(12 cm × 14 cm) Meckel's diverticulum at the site of obstruction. Meckel's diverticulum was axially rotated by 720°, which caused small bowel obstruction and diverticular necrosis. About 20 cm of the small bowel with Meckel's diverticulum was resected. The postoperative course was uneventful and the patient was discharged on the fifth postopera-tive day. We recommend CT-scan as the most useful diagnostic tool in bowel obstruction of unknown origin. In cases of Meckel's diverticulum causing small bowel obstruction, prompt surgical treatment is indicated; de-lay in diagnosis and in adequate treatment may lead to bowel necrosis and peritonitis.     

Neuropathy caused by spontaneous intraneural hemorrhage: case report.

A case of ulnar neuropathy at the elbow produced by spontaneous intraneural hemorrhage in a patient with acquired immunodeficiency syndrome and thrombocytopenia is reported. Intraneural hemorrhage in patients with bleeding disorders occurs infrequently. It consists of acute intrafascicular bleeding, presumably producing very high elevations of endoneurial fluid pressure. The clinical features and treatment of this condition are considered, the pertinent literature is reviewed, and the involved pathophysiological mechanisms are discussed.     

Hydronephrosis presenting as the first sign of malignant lymphoma of the small intestine: report of a case

A 45-year-old man was admitted to hospital on November 26, 1985 with the chief complaint of left hypochondrial pain. Excretory and retrograde pyelography revealed left hydronephrosis due to extrinsic obstruction of ureter. Computerized tomography and angiography revealed that a tumor of the small intestine was the cause of ureteral obstruction. In addition to the presence of a tumor, a fistula in the small intestine was disclosed on the upper gastrointestinal series. During the operation, a large mass which involved several organs was identified without mobility. The sophisticated operation was composed of wide resection of small intestine including the tumor, left hemicolectomy, left nephroureterectomy, splenectomy, partial pancreatectomy, duodeno-ileostomy and transverse sigmoidostomy was done on December 19, 1985. Pathological diagnosis was malignant lymphoma, diffuse small cell type infiltrating ureter, kidney and perirenal connective tissue. Because of poor postoperative course systemic chemotherapy was not performed and he died of disseminated intravascular coagulation on April 2, 1986.     

Bowel obstruction caused by a Meckel's diverticulum enterolith: a case report and review of the literature

Meckel's diverticulum is the most common congenital gastrointestinal anomaly. It may infrequently cause bleeding, perforation, or rarely obstruction. Formation of enteroliths in the diverticulum is uncommon. We present a case of small bowel obstruction from an expelled enterolith.