Laparoscopic Resection of a Congenital Gastric Diverticulum that was Found Incidentally on Imaging: A Case Report.

Gastric diverticula are quite rare and can be either acquired or congenital. Resection is recommended when the diverticula are large (>4 cm), PPI therapy does not relieve symptoms, and/or complications arise. We present a case of a patient with a long-standing history of symptoms related to a congenital gastric diverticulum that had been found incidentally on imaging during a workup for possible small bowel obstruction. The patient underwent a successful laparoscopic, robotic assisted surgical resection of the congenital gastric diverticulum with complete relief of his symptoms.

[Diagnosis and surgical treatment of symptomic stomach diverticulum]. / Diagnostika i khirurgicheskoe lechenie simptomnogo divertikula zheludka.

Gastric diverticulum is a rather rare disease. This lesion is diagnosed in about 0.01% of cases during contrast-enhanced X-ray examination and in 0.04-0.11% of patients undergoing endoscopic examination. Symptomatic diverticulum is complicated by diverticulitis, bleeding, perforation and malignant transformation. Therefore, surgical resection is indicated. We report surgical treatment of a patient with diverticulum of the cardiac part of the stomach. Endoscopic and X-ray examination was valuable to establish the correct diagnosis. Laparoscopic approach minimized surgical trauma and reduced surgery time.

Laparoscopic resection of symptomatic gastric diverticula.

Gastric diverticula are rare and usually asymptomatic. This report, however, describes two examples of symptomatic gastric diverticula successfully treated by laparoscopic resection. Both patients were male and in their sixth decade of life. One patient was relatively healthy with no past medical history, whereas the other patient had chronic pain issues and at presentation was also undergoing evaluation for hyperaldosteronism. The patients presented with gastrointestinal symptoms, including nausea, emesis, abdominal pain, and change in bowel function. In both cases, a gastric diverticulum was identified by CT scan, and precise anatomic position was determined by upper endoscopy. After discussion with the treating teams, including a gastroenterologist and surgeon, surgical treatment and resection was elected. Successful laparoscopic removal was accomplished in both patients, and they were discharged home after tolerating liquid diets. Both patients reported resolution of their abdominal symptoms at follow-up.

Large symptomatic gastric diverticula: two case reports and a brief review of literature.

Gastric diverticula are rare and uncommon conditions. Most gastric diverticula are asymptomatic. When symptoms arise, they are most commonly upper abdominal pain, nausea and emesis, while dyspepsia and vomiting are less common. Occasionally, patients with gastric diverticula can have dramatic presentations related to massive bleeding or perforation. The diagnosis may be difficult, as symptoms can be caused by more common gastrointestinal pathologies and only aggravated by diverticula. The appropriate management of diverticula depends mainly on the symptom pattern and as well as diverticulum size. There is no specific therapeutic strategy for an asymptomatic diverticulum. Although some authors support conservative therapy with antacids, this provides only temporary symptom relief since it is not able to resolve the underlying pathology. Surgical resection is the mainstay of treatment when the diverticulum is large, symptomatic or complicated by bleeding, perforation or malignancy, with over two-thirds of patients remaining symptom-free after surgery, while laparoscopic resection, combined with intraoperative endoscopy, is a safe and feasible approach with excellent outcomes. Here, we present two cases of uncommon large symptomatic gastric diverticula with a discussion of the cornerstones in management and report a minimally invasive solution, with a brief review of the literature.

[Diverticulum of the greater curvature of the stomach as a cause of anaemia]. / Divertikul velkej kurvatúry zalúdka ako prícina anemizácie.

Gastric diverticula represent a rare pathological condition. They are usually asymptomatic and are often found only by accident during radiologic or endoscopic examination, or during autopsy. Their incidence is low and evenly distributed between men and women. Gastric diverticula are most frequently located on the posterior wall of the cardia and on the lesser curvature of the stomach. The authors present a case study of a 58-year-old patient with severe sideropenic anaemia, a marked weight loss and non-specific dyspeptic symptoms. The suspicion of a diverticulum was raised by a gastroenterologist during gastrofibroscopy and confirmed by a radiologist following a dynamic CT examination of the stomach. The diverticulum had an atypical location beneath the cardia on the greater curvature. The patient was indicated for surgery. During conventional laparotomy, resection of the diverticulum was performed using a linear stapler. The postoperative course was uneventful. Histology confirmed a false diverticulum. The patient is doing well, is asymptomatic, has put on 7 kg since the operation and her blood count is normal.

Gastric diverticulum: "a wayside house of ill fame" with a laparoscopic solution.

BACKGROUND: Gastric diverticulum (GD) is an extremely rare disorder that can easily be overlooked when investigating the cause of abdominal pain. Its diagnosis is founded on a history of gastrointestinal symptoms and a typically unrevealing physical examination, and diagnosis requires confirmation from UGI contrast studies, EGD, and CT scan. Symptomatic GD should be kept in consideration as a cause of abdominal issues, because not only is it treatable, but also complications of GD can be life threatening. The surgical treatment of GDs has evolved from thoraco-abdominal incisions in the early twentieth century to the laparoscopic approach used today. CASE REPORT: The patient is a 45-y-old male presenting with a 4-mo case of dysphagia, small amounts of regurgitation, and abdominal pain but no other symptoms. RESULTS: The patient was diagnosed with a gastric diverticulum, which was subsequently successfully treated with a laparoscopic gastric diverticulectomy. CONCLUSION: Laparoscopic gastric diverticulectomy is a safe procedure and should be considered as an option to treat symptomatic GD.

Adenocarcinoma arising in an intramural diverticulum presenting as a long-standing submucosal tumor.

We report a rare case of adenocarcinoma arising in a gastric partial diverticulum in the upper portion of the stomach. The lesion had been followed up for approximately 14 years as a gastric submucosal tumor. However, a recent regular check-up revealed mucous material with some neoplastic tissue discharged from the top of the lesion. A surgically resected specimen showed a well-demarcated submucosal lesion identical to a pseudo-diverticulum carrying a distinctive intramucosal minimally invasive adenocarcinoma in part, with surrounding non-neoplastic but hyperplastic mucosal components. Intestinal phenotype, along with gastric foveolar, pyloric gland-type phenotypes, and neoplastic cells with neuroendocrine differentiation, were also identified in the adenocarcinoma. Chronic and persistent irritation within the diverticulum was postulated to be implicated in the carcinogenesis of the lesion, which carried no definite Helicobacter pylori microorganisms. We believe it is crucial not to overlook carcinoma in a diverticulum presenting as a long-standing submucosal tumor.

Divertículo duodenal perforado como causa de abdomen agudo quirúrgico / Perforated duodenal diverticulum as cause of surgical acute abdomen

La enfermedad diverticular duodenal es considerada en el ámbito de la cirugía de vías digestivas como inusual. Por su parte, la complicación menos frecuente referida en la literatura médica lo constituye la perforación aguda, y cuando esta ocurre siempre se practicará tratamiento quirúrgico de urgencia. Resulta polémico llegar a un consenso general que dirija la metodología diagnóstica, debido a su atípica forma de presentación. La tomografía abdominal ha resultado de gran utilidad en el diagnóstico de esta entidad. Se reportan tasas de mortalidad altas (25-30 por ciento) originadas, generalmente, por la dificultad diagnóstica frente a esta enfermedad. Se presenta un nuevo caso de divertículo duodenal perforado en una paciente, del sexo femenino, de 60 años de edad. La técnica quirúrgica empleada en esta oportunidad consistió en la exclusión duodenal y el drenaje del retroperitoneo(AU)

The duodenal diverticular disease is considered within surgery of digestive tracts as unusual. The less frequent complication referred in medical literature is the acute perforation and when it occurs always will be carried out the emergency surgical treatment. It is polemic to arrive to a general consensus directing the diagnostic methodology due to its atypical way of presentation. The abdominal tomography has been very useful in diagnosis of this entity. Authors report high mortality rates (25-30 percent) in general originated by the diagnostic difficulty in face of this disease. A new case of perforated duodenal diverticulum of a female sex patient aged 60. The surgical technique used in this opportunity was the duodenal exclusion and the retroperitoneal drainage(AU)