RESUMEN
This report describes the case of a 62-year-old male patient in Saudi Arabia who developed a diverticular pouch in his oral cavity. Diverticula are rare conditions that appear as protrusions or pouches within the digestive tract's inner lining. The condition can occur in different parts of the digestive system, but the colon is the most affected part. As part of the patient's symptoms, he presented with dysphagia, weight loss, and globus sensations. Multiple diagnostic tests, including ultrasound, computerized tomography (CT), and magnetic resonance imaging (MRI), did not identify the diverticula. Barium and upper gastrointestinal studies were the diagnostic tests that provided accurate diagnoses where several diverticula were discovered during the videofluoroscopic swallow study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES). Surgical intervention was recommended by the multidisciplinary team; however, the patient rejected this treatment option. This report highlights the necessity for instrumental swallowing diagnostic evaluation in the workup of the infrequent etiologies of dysphagia and suggests a gap in the current knowledge, prompting further studies on the etiology, incidence, and optimum management of upper gastrointestinal (GI) tract diverticular disease.
Asunto(s)
Trastornos de Deglución , Humanos , Masculino , Trastornos de Deglución/etiología , Trastornos de Deglución/diagnóstico , Persona de Mediana Edad , Divertículo/complicaciones , Divertículo/diagnóstico , Divertículo/diagnóstico por imagen , Arabia Saudita , FluoroscopíaRESUMEN
We present a case of a 45-year-old male with symptomatic supraventricular tachycardia. Electrophysiology study and 3-dimensional (3D) electroanatomic mapping showed a focal atrial tachycardia originating from a large left atrial diverticulum. Due to the unusual anatomy, 3D printing models were used to aid successful catheter ablation of the atrial tachycardia.
Asunto(s)
Ablación por Catéter , Divertículo , Técnicas Electrofisiológicas Cardíacas , Atrios Cardíacos , Impresión Tridimensional , Taquicardia Supraventricular , Humanos , Masculino , Persona de Mediana Edad , Taquicardia Supraventricular/cirugía , Taquicardia Supraventricular/fisiopatología , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/etiología , Divertículo/cirugía , Divertículo/complicaciones , Divertículo/fisiopatología , Divertículo/diagnóstico por imagen , Atrios Cardíacos/cirugía , Atrios Cardíacos/fisiopatología , Atrios Cardíacos/diagnóstico por imagen , Resultado del Tratamiento , Modelos Cardiovasculares , Modelación Específica para el Paciente , Frecuencia Cardíaca , Potenciales de AcciónAsunto(s)
Colangitis , Enfermedades Duodenales , Recurrencia , Esfinterotomía Endoscópica , Humanos , Esfinterotomía Endoscópica/métodos , Colangitis/etiología , Colangitis/cirugía , Enfermedades Duodenales/cirugía , Enfermedades Duodenales/etiología , Divertículo/cirugía , Divertículo/complicaciones , Masculino , Femenino , Obstrucción Duodenal , Atresia IntestinalRESUMEN
Perforation is the rarest complication of duodenal diverticulum but also one of its most serious complications. Mortality rate was reported to up to 30%. Clinical diagnosis is usually vague and non-specific. High clinical suspicion is important as rapid deterioration is likely. Consensus regarding management is lacking and currently guided by a small series of case reviews. Surgical treatment is historically the standard therapeutic option. However, more current literature suggests improvement in patients with non-surgical management. In this paper, we discuss a case of a patient in her early 60s who had a perforated duodenal diverticulum that was treated conservatively. It highlights the importance of a good history and a CT scan to help with diagnosis. Close clinical observation is essential to detect disease progression. A step-up approach to clinical deterioration with either percutaneous drainage or surgical management should be considered if the patient does not respond to conservative treatment.
Asunto(s)
Tratamiento Conservador , Divertículo , Enfermedades Duodenales , Perforación Intestinal , Tomografía Computarizada por Rayos X , Humanos , Divertículo/complicaciones , Divertículo/terapia , Divertículo/diagnóstico por imagen , Femenino , Enfermedades Duodenales/terapia , Enfermedades Duodenales/diagnóstico por imagen , Enfermedades Duodenales/cirugía , Perforación Intestinal/cirugía , Perforación Intestinal/terapia , Perforación Intestinal/etiología , Perforación Intestinal/diagnóstico por imagen , Persona de Mediana EdadRESUMEN
Intracranial hypotension may result in pituitary gland enlargement due to compensatory hyperaemia and venous engorgement. Spontaneous intracranial hypotension (SIH) is frequently associated with connective tissue disorders predisposing patients to dural weakening including dural ectasia and meningeal diverticula. Symptoms of SIH typically include postural headache, dizziness and tinnitus. We present a case of a female in her 20s with Marfan syndrome and a history of pituitary adenoma, who reported intractable postural headaches. Hormonal workup revealed no abnormalities, whereas brain MRI showed sequelae of intracranial hypotension. Further MRI studies revealed thoracic and lumbar meningeal diverticula with significant dural sac ectasia at the L4-S2 level. Myelogram confirmed numerous lumbar spine diverticula with cerebrospinal fluid leak at the L5 and S1 right nerve roots. The patient underwent blood patch administrations at the level of the leak with improvement of symptoms.
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Pérdida de Líquido Cefalorraquídeo , Hipotensión Intracraneal , Imagen por Resonancia Magnética , Síndrome de Marfan , Neoplasias Hipofisarias , Humanos , Femenino , Síndrome de Marfan/complicaciones , Síndrome de Marfan/diagnóstico , Neoplasias Hipofisarias/complicaciones , Neoplasias Hipofisarias/diagnóstico por imagen , Pérdida de Líquido Cefalorraquídeo/etiología , Pérdida de Líquido Cefalorraquídeo/diagnóstico por imagen , Pérdida de Líquido Cefalorraquídeo/complicaciones , Adulto , Hipotensión Intracraneal/etiología , Hipotensión Intracraneal/terapia , Hipotensión Intracraneal/diagnóstico , Adenoma/complicaciones , Adenoma/diagnóstico por imagen , Parche de Sangre Epidural , Cefalea/etiología , Divertículo/complicaciones , Divertículo/diagnósticoAsunto(s)
Divertículo , Neoplasias Ureterales , Humanos , Divertículo/cirugía , Divertículo/diagnóstico por imagen , Divertículo/complicaciones , Divertículo/congénito , Neoplasias Ureterales/patología , Neoplasias Ureterales/cirugía , Neoplasias Ureterales/complicaciones , Enfermedades Ureterales/congénito , Enfermedades Ureterales/cirugía , Enfermedades Ureterales/diagnóstico por imagen , Enfermedades Ureterales/complicaciones , Masculino , Carcinoma de Células Transicionales/cirugía , Carcinoma de Células Transicionales/patología , Carcinoma de Células Transicionales/diagnóstico por imagen , Carcinoma de Células Transicionales/complicaciones , FemeninoRESUMEN
Sigmoid sinus diverticulum is a rare vascular anomaly often associated with pulsatile tinnitus. It can occur in cases of chronic otitis media squamous type (unsafe type) due to dehiscence of the sigmoid sinus plate caused by cholesteatoma. The presentation of which is that of pulsatile tinnitus. However, we present an unusual case of sigmoid sinus diverticulum occurring concurrently with chronic otitis media mucosal type (safe type) but in the absence of pulsatile tinnitus. This case report highlights the diagnostic challenges and management of this rare clinical scenario.
Asunto(s)
Senos Craneales , Divertículo , Otitis Media , Acúfeno , Humanos , Divertículo/complicaciones , Divertículo/diagnóstico por imagen , Divertículo/diagnóstico , Acúfeno/etiología , Enfermedad Crónica , Senos Craneales/anomalías , Senos Craneales/diagnóstico por imagen , Senos Craneales/patología , Otitis Media/complicaciones , Masculino , Tomografía Computarizada por Rayos X , FemeninoAsunto(s)
Divertículo , Duramadre , Hipotensión Intracraneal , Meninges , Humanos , Hipotensión Intracraneal/diagnóstico por imagen , Divertículo/diagnóstico por imagen , Divertículo/complicaciones , Duramadre/diagnóstico por imagen , Duramadre/patología , Meninges/diagnóstico por imagen , Meninges/patología , Imagen por Resonancia Magnética , Diagnóstico Diferencial , Pérdida de Líquido Cefalorraquídeo/diagnóstico por imagen , Pérdida de Líquido Cefalorraquídeo/etiologíaRESUMEN
INTRODUCTION: Acquired bladder diverticula (BD) are associated with bladder outlet obstruction. The aim of our study is to analyse the improvement in lower urinary tract symptoms (LUTS) in patients who underwent robot-assisted bladder diverticulectomy (RABD) combined with transurethral prostatectomy (TURP). MATERIAL AND METHODS: A prospectively single-centre, single surgeon cohort of four patients with posterolateral BD due to bladder outlet obstruction (BOO) undergoing RABD combined with TURP between 2018 and 2023 was analysed. RESULTS: Median age and maximum BD diameter were 73.5 years and 16 cm, respectively. All patients had severe LUTS and elevated postvoid residual (PVR). Preliminary uroflowmetry revealed bladder outlet obstruction with a median of maximum urine flow rate of 8.5 ml/s. The median operative time and blood loss were 212 min and 100 ml, respectively. No intraoperative complications were recorded. The median length of stay was 4 days. The International Prostate Symptom Score (IPSS) and PVR were compared between baseline, 1 month and 6 months after surgery. IPSS significantly decreased from 24 (IQR 24-25) preoperatively compared to the postoperative, at 1 month follow up 7 (IQR 6-8) (p < 0.0001). PVR significantly decreased too from 165 (IQR 150-187) to 35 ml (IQR 25-42) (p < 0.0001). In transitioning from the 1-month follow-up to the 6-month follow-up, no substantial statistical improvement was observed. CONCLUSION: Concomitant performance of TURP with RABD is feasible and safe. Diverticulectomy in addiction at the endoscopic procedure should be discussed with patients who have obstructive lower urinary tract symptoms as viable alternative to single procedure individually performed.
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Divertículo , Procedimientos Quirúrgicos Robotizados , Obstrucción del Cuello de la Vejiga Urinaria , Humanos , Obstrucción del Cuello de la Vejiga Urinaria/cirugía , Masculino , Anciano , Procedimientos Quirúrgicos Robotizados/métodos , Divertículo/cirugía , Divertículo/complicaciones , Estudios Prospectivos , Resección Transuretral de la Próstata/métodos , Vejiga Urinaria/cirugía , Vejiga Urinaria/anomalías , Persona de Mediana EdadRESUMEN
The combination of the right aortic arch and aberrant left subclavian artery (ALSA) with Kommerell's diverticulum (KD) is rare to coexist with the left innominate vein (LINV) beneath the aortic arch. It escalates the surgical risk undoubtedly and increases the difficulty of clinical procedures. We report one case diagnosed by Ultrasound and Computed Tomography Angiography (CTA).
Asunto(s)
Aorta Torácica , Venas Braquiocefálicas , Divertículo , Arteria Subclavia , Humanos , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/anomalías , Divertículo/diagnóstico por imagen , Divertículo/complicaciones , Venas Braquiocefálicas/anomalías , Venas Braquiocefálicas/diagnóstico por imagen , Arteria Subclavia/anomalías , Arteria Subclavia/diagnóstico por imagen , Angiografía por Tomografía Computarizada/métodos , Masculino , Femenino , Ecocardiografía/métodos , Anomalías Múltiples , Aneurisma/complicaciones , Aneurisma/diagnóstico por imagen , Anomalías Cardiovasculares/complicaciones , Anomalías Cardiovasculares/diagnóstico por imagenAsunto(s)
Divertículo , Atrios Cardíacos , Humanos , Divertículo/complicaciones , Divertículo/diagnóstico por imagen , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/anomalías , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/etiología , Cardiopatías/diagnóstico por imagen , Cardiopatías/complicaciones , Cardiopatías/diagnóstico , Masculino , Femenino , Persona de Mediana Edad , ElectrocardiografíaRESUMEN
Congenital diverticulum is an uncommonly detected cardiac lesion, especially in infancy. However, its association with cyanotic congenital heart disease is extremely rare. In the current work, we report a case diagnosed in the neonatal period with tetralogy of Fallot and pulmonary valve atresia associated with a large congenital diverticulum originating from the right ventricle.
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Divertículo , Ventrículos Cardíacos , Atresia Pulmonar , Tetralogía de Fallot , Humanos , Tetralogía de Fallot/complicaciones , Tetralogía de Fallot/diagnóstico por imagen , Atresia Pulmonar/complicaciones , Atresia Pulmonar/diagnóstico por imagen , Divertículo/complicaciones , Divertículo/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/anomalías , Recién Nacido , Ecocardiografía/métodos , Masculino , Anomalías Múltiples , Femenino , Diagnóstico DiferencialRESUMEN
BACKGROUND Jejunal diverticulosis are false diverticula of the small bowel that form from outpouching of the mucosa and submucosa. They are pulsion diverticula that are often asymptomatic and can be found incidentally during surgery. In some instances, jejunal diverticula could result in intestinal obstruction. Small intestinal volvulus is an uncommon cause of small bowel obstruction that results in a closed loop obstruction and is an indication for emergent surgical intervention. CASE REPORT We report a case of an 84-year-old man who presented to the Emergency Department with abdominal pain and generalized weakness. A preoperative computerized tomographic scan demonstrated a closed loop small bowel obstruction with mesenteric swirling. The patient was taken for a diagnostic laparoscopy, which revealed extensive proximal jejunal diverticulosis and a volvulus of the involved jejunum. An exploratory laparotomy was warranted for safe detorsion of the small bowel and resection of the diseased segment. The small bowel was successfully detorsed, with resection of the involved jejunum. Intestinal continuity was established by a primary side-to-side anastomosis. CONCLUSIONS Jejunal diverticula have been reported in the literature as a cause of small bowel obstructions, and very few reports exist of concurrent small bowel volvulus. In very rare instances, both of these conditions can coexist. There should be prompt surgical intervention in all cases of closed loop small bowel obstructions to prevent intestinal ischemia, perforation, and sepsis.
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Divertículo , Obstrucción Intestinal , Vólvulo Intestinal , Intestino Delgado , Enfermedades del Yeyuno , Anciano de 80 o más Años , Humanos , Masculino , Divertículo/complicaciones , Divertículo/cirugía , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Vólvulo Intestinal/etiología , Vólvulo Intestinal/cirugía , Intestino Delgado/anomalías , Enfermedades del Yeyuno/cirugía , Enfermedades del Yeyuno/complicaciones , Enfermedades del Yeyuno/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND The gallbladder develops from the hepatic diverticulum during the fourth week of gestation, which also give rise to the liver, extrahepatic biliary ducts, and ventral part of the pancreas. Infrequently, the gallbladder has malformation or disruption in embryogenesis, leading to congenital anomalies. There are various congenital anomalies that can arise in the gallbladder. True or congenital diverticulum of the gallbladder is a rare entity that accounts for only 0.06% of gallbladder congenital anomalies and 0.0008% of cholecystectomies at the Mayo Clinic. CASE REPORT Herein, we report a rare case of a 38-year-old woman who presented to Jubail General Hospital's surgery clinic with right upper-quadrant (RUQ) pain associated with vomiting after meals for 1 month. Laparoscopic cholecystectomy was done and gallbladder tissue was sent to histopathology. Gross examination revealed an outpouching mucosa within the wall that was proven to consist of muscularis and serosa layers under light microscope. Interestingly, xanthogranulomatous inflammation was confined to the diverticulum, unlike the chronic inflammation involving the remaining gallbladder. Based on the above findings, the diagnosis of congenital diverticulum with xanthogranulomatous cholecystitis was made. CONCLUSIONS Gallbladders associated with a true diverticulum are uncommonly found to be buried in the liver, leading to surgical difficulties during cholecystectomy. Therefore, background knowledge of occasional anomalies plays a crucial role in guiding the surgeon to choose the optimal method of management. We also discuss the associated complications that accompany these anomalies, such as non-specific prolonged ailments, acalculous cholecystitis, cholecystitis and cholelithiasis, recurrent cholangitis, and carcinoma of the gallbladder.
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Colecistitis , Divertículo , Vesícula Biliar , Xantomatosis , Humanos , Femenino , Adulto , Xantomatosis/cirugía , Xantomatosis/diagnóstico , Colecistitis/cirugía , Colecistitis/diagnóstico , Divertículo/cirugía , Divertículo/diagnóstico , Divertículo/complicaciones , Vesícula Biliar/anomalías , Vesícula Biliar/patología , Granuloma/cirugía , Granuloma/diagnóstico , Colecistectomía LaparoscópicaAsunto(s)
Divertículo Esofágico , Enfermedades de la Tráquea , Humanos , Divertículo Esofágico/complicaciones , Divertículo Esofágico/diagnóstico por imagen , Enfermedades de la Tráquea/complicaciones , Enfermedades de la Tráquea/diagnóstico por imagen , Masculino , Divertículo/complicaciones , Divertículo/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Persona de Mediana Edad , FemeninoAsunto(s)
Divertículo , Esofagoscopía , Enfermedades de la Tráquea , Fístula Traqueoesofágica , Humanos , Fístula Traqueoesofágica/diagnóstico por imagen , Fístula Traqueoesofágica/complicaciones , Fístula Traqueoesofágica/cirugía , Esofagoscopía/métodos , Divertículo/complicaciones , Divertículo/diagnóstico por imagen , Enfermedades de la Tráquea/diagnóstico por imagen , Enfermedades de la Tráquea/complicaciones , Masculino , Femenino , Persona de Mediana EdadRESUMEN
A jejunal diverticular haemorrhage is the second most common complication of jejunum diverticula. It can manifest clinically as acute upper gastrointestinal bleeding and is common to imitate acute rectal bleeding. Bleeding is usually associated with or without haemodynamic stability. Its diagnosis is challenging, requiring imaging examinations. Treatment is conservative management or surgery.
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Divertículo , Hemorragia Gastrointestinal , Enfermedades del Yeyuno , Humanos , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Enfermedades del Yeyuno/diagnóstico , Enfermedades del Yeyuno/complicaciones , Enfermedades del Yeyuno/cirugía , Divertículo/complicaciones , Divertículo/diagnóstico , Divertículo/diagnóstico por imagen , Masculino , Anciano , Femenino , Tomografía Computarizada por Rayos X , Diagnóstico DiferencialAsunto(s)
Divertículo , Enfermedades del Íleon , Intususcepción , Divertículo Ileal , Adulto , Humanos , Intususcepción/etiología , Intususcepción/cirugía , Divertículo Ileal/complicaciones , Divertículo Ileal/diagnóstico por imagen , Divertículo Ileal/cirugía , Divertículo/complicaciones , Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Íleon/etiología , Enfermedades del Íleon/cirugíaRESUMEN
Ventricular diverticula are saccule-like structures formed by the protrusion of the ventricular myocardium from the endocardial surface towards the free wall. Most diverticula are muscular structures, and patients usually have no obvious clinical symptoms. However, diverticula may contribute to arrhythmogenesis due to localized myocardial structural disturbances. Right ventricular apical diverticulum (RVAD) is very rare, and we report a case of highly symptomatic accelerated idioventricular rhythm (AIVR) originating from the RVAD that underwent intracardiac echocardiography (ICE)-guided catheter ablation with no recurrence during follow-up.