Multi-slice spiral computed tomography diagnosis of juxta-papillary duodenal diverticulum and its relationship with biliopancreatic diseases.

BACKGROUND: Juxta-papillary duodenal diverticula (JPDD) are common but are usually asymptomatic, and they are often diagnosed by coincidence. OBJECTIVE: To analyse the anatomy and classification of JPDD and its relationship with biliary and pancreatic disorders, and to explore the diagnostic value of multi-slice spiral computed tomography (MSCT) in patients with JPDD. METHODS: The imaging data of patients with JPDD, which was obtained via abdominal computed tomography examination and confirmed via gastroscopy and/or upper gastrointestinal barium enema, in our hospital from 1 January 2019 to 31 December 2020 were retrospectively analysed. All patients were scanned using MSCT, and the imaging findings, classification and grading were analysed. RESULTS: A total of 119 duodenal diverticula were detected in 96 patients, including 73 single diverticula and 23 multiple diverticula. The imaging findings were mainly cystic lesions of the inner wall of the duodenum protruding to the outside of the cavity. The thin layer showed a narrow neck connected with the duodenal cavity, and the shape and size of the diverticula were different: 67 central-type cases and 29 peripheral-type cases. There were 50 cases of type I, 33 cases of type II, 19 cases of type III and six cases of type IV. Furthermore, there were seven small, 87 medium and 14 large diverticula. The differences in the location and size of the JPDD in MSCT grading were statistically significant (P< 0.05). CONCLUSION: The MSCT method has an important diagnostic value for the classification of JPDD, and MSCT images are helpful in the clinical evaluation of patients with JPDD and the selection of treatment options.

Otopathologic and Computed Tomography Correlation of Internal Auditory Canal Diverticula in Otosclerosis.

INTRODUCTION: Internal auditory canal (IAC) diverticula, also known as IAC cavitary lesions or anterior cupping of the IAC, observed in otopathologic specimens and high-resolution computed tomography (CT) scans of the temporal bone are thought to be related to otosclerosis. Herein, we examined the usefulness of CT scans in identifying diverticula and determined whether IAC diverticula are associated with otosclerosis on otopathology. METHODS: One hundred five consecutive specimens were identified from the National Temporal Bone Hearing and Balance Pathology Resource Registry. Inclusion criteria included the availability of histologic slides and postmortem specimen CT scans. Exclusion criteria included cases with severe postmortem changes or lesions causing bony destruction of the IAC. RESULTS: Ninety-seven specimens met criteria for study. Of these, 42% of the specimens were from male patients, and the average age of death was 77 years (SD = 18 yr). IAC diverticula were found in 48 specimens, of which 46% were identified in the CT scans. The mean area of the IAC diverticula was 0.34 mm 2 . The sensitivity and specificity of detecting IAC diverticula based on CT were 77% and 63%, respectively. Overall, 27% of specimens had otosclerosis. Histologic IAC diverticula were more common in specimens with otosclerosis than those without (37.5% versus 16%; p = 0.019). Cases with otosclerosis had a greater mean histologic diverticula area compared with nonotosclerosis cases (0.69 mm 2 versus 0.14 mm 2 ; p = 0.001). CONCLUSION: IAC diverticula are commonly found in otopathologic specimens with varied etiologies, but larger diverticula are more likely to be associated with otosclerosis. The sensitivity and specificity of CT scans to detect IAC diverticula are limited.

Intramural diverticulosis and diverticulitis of the colon: Pictorial essay.

Diverticulosis of the colon is a gradually progressive disease that usually starts in early adulthood and increases with advancing age in its anatomical extent and the size of diverticula. It is important to recognize the initial stages of diverticular development in young patients in order to properly diagnose and manage the potential complications of this very common intestinal disorder. This article presents the pathological and radiological features of early diverticular formation, when the mucosal outpouchings are very small and contained within the colonic wall as distinct intramural lesions. The subsequent development of intramural diverticulitis and the spectrum of its manifestations on barium enema examination or Computed tomography (CT) are illustrated.

Pulsion diverticula of the rectum: Radiological diagnosis and clinical implications.

INTRODUCTION: The aim of this study was to investigate the appearance of acquired rectal diverticula on barium enema and computed tomography (CT) and to review the pertinent clinical data about this entity. METHODS: This series included 3 men and 6 women, who ranged in age from 47 to 82 years (average: 64 years). Air-contrast barium enema in 6 patients with history of anorectal disease or obstructed defecation demonstrated rectal diverticula. In these cases, multiple radiographs of the rectosigmoid region were obtained in upright position while the patient was relaxing or straining without any attempt to evacuate the barium. In 3 cases, the lateral rectal diverticula were incidental finding on CT studies that were performed for various unrelated abdominal complaints. RESULTS: Pulsion type of diverticulum presenting as a wide-neck outpouching was detected on the lateral rectal wall in 5 and on the posterior wall in 4 patients. They measured 2-3 cm in diameter when filled with contrast material or gas, and became even larger when the intraluminal pressure was increased by straining. CONCLUSION: Pulsion diverticula of the rectum present as a wide-neck outpouching of the lateral or posterior rectal wall in adult patients. This acquired abnormality is usually associated with coexisting anorectal lesions or defecation disorders. The practising radiologists and colorectal surgeons should be aware of this uncommon condition, its appearance on barium enema and other imaging studies, and its clinical implications.

A congenital diverticulum of the left ventricular apex manifested by stroke and recurrent ventricular tachycardia.

Ventricular outpouchings include acquired abnormalities (aneurysms and pseudoaneurysms) and congenital ventricular diverticula (CVD). CVD represent rare cardiac pathologies. Although CVD is often associated with other cardiac and extracardiac congenital anomalies, it can also be incidentally observed in otherwise healthy subjects. CVD may lead to significant morbidity and even have lethal consequences. We describe a case of arrhythmogenic left ventricle (LV) apical CVD revealed by cardiac magnetic resonance imaging (CMRI) after being initially overlooked by echocardiography. The paper includes the review of the literature also. This clinical case highlights the possible association of this pathology with recurrent ventricular tachycardia and stroke, and illustrates the importance of multimodal imaging approach in differential diagnosis.

Iatrogenic rectal diverticulum in patients treated with transanal stapled techniques.

PURPOSE: The aim of this study was to demonstrate the possibility of rectal diverticula developing in patients treated with endoanal circular staplers for haemorrhoids (Longo's stapled haemorrhoidectomy) or obstructed defaecation syndrome [stapled transanal rectal resection (STARR)]. MATERIALS AND METHODS: Between January 2005 and December 2006, we carried out 634 defaecographic examinations. Of these, 45 were postoperative follow-up studies of patients who had been treated with the Longo technique (n = 13) or STARR technique (n = 32). RESULTS: Seven out of 45 patients, five of whom were women treated with the Longo technique and two men with the STARR technique, developed rectal diverticula. One diverticulum was located on the left lateral rectal wall, four on the posterior wall and two on the anterior wall. All diverticula had arisen from the surgical suture point. In one case, the diverticulum was discovered incidentally during a double-contrast barium enema. One of the male patients, who had been treated with the Longo procedure 5 years earlier, developed acute pain due to faecal stasis in a widenecked diverticulum abutting the posterior rectal wall. CONCLUSIONS: The use of endorectal stapling devices can lead to focal weakness at the point of surgical suture on the rectal wall and predispose to the development of rectal diverticula.

Colonic diverticulosis in Enugu Nigeria: the prevalence and distributional pattern

A retrospective study on the pattern and prevalence of colonic diverticulosis of inhibitory in Enugu; Nigeria was carried out. Radiographs and reports of past Barium Enema examinations done over a 10 year period were reviewed and analysed. The prevalence of this disease entity in our community is 6.52

[Endoscopic treatment of bladder diverticula]. / Endoskopicheskoe lechenie divertikulov mochevogo puzyria.

Transurethral endoscopic incision of the urinary bladder's diverticular neck has been performed in 29 patients aged 44 to 90 years (mean age 65 years). 25(86.2%) patients had verified concomitant diseases and high anesthesia risk prohibiting radical surgery. According to preoperative diagnosis, the volume of the diverticula ranged from 20 to 700 ml, the diameter of the neck--from 0.3 to 2.0 cm. 10 patients had multiple diverticula. Uroflowmetry registered the maximal urinary flow rate (Qmax) within 2.1-5.3 ml/s. In all the patients surgery was performed under epidural anesthesia, simaltaneously with transurethral resection (TUR) of benign prostatic hyperplasia in 18 patients, with TUR of the urinary bladder neck or incision of the prostate because of its sclerosis in 11 patients. In 2 cases there was also TUR of the bladder for papillary cancer involving the bladder wall and the diverticulum, in 6 cases one-stage pneumatic or mechanical cystolithotripsy was performed. No intraoperative complications occurred. After the operation all the patients resumed normal micturition. Control examination after 6-48-month follow-up Qmax rose to 14.1-23.0 ml/s. Neither ultrasound investigation nor cystography detected diverticulum in 13 patients. The size of the diverticulum diminished in size in 16 patients. Residual urine in large diverticula (14 patients) was 50 ml maximum. 12 months after the operation 1 patient developed recurrent sclerosis of the prostate with reappearance of residual urine. He was reoperated (TUR of the prostate) without incision of the neck of the diverticulum. Postoperative complications were the following: mild electric burn of the thigh (1 case), acute epididimitis treated conservatively (1 case) and early postoperative bleeding which required endoscopic revision of the bladder and coagulation of the bleeding vessel from the cut neck of the diverticulum (1 case). Thus, transurethral incision of the bladder's diverticular neck is effective and low-traumatic intervention which in patients with severe somatic pathology is an alternative to the open surgery, while in patients without such pathology it does not complicate open operation (diverticulectomy) if it becomes necessary.

Radiological diagnosis and management of diverticulitis.

Thirteen (13) patients with proven diverticulitis are presented with the aim of demonstrating the current evaluation and management. Radiological evaluation were obtained with plain abdominal x-rays and computed tomography (CT) in all cases, abdominal ultrasonography (US) in 8 cases and contrast enema in 5 patients. Radiological percutaneous abscess drainage (PAD) were performed in 5 cases, two of which preceded surgery. A clinical suspicion of diverticulitis was made in only 3 of the 13 cases. CT provided the diagnosis in all cases and helped in directing the appropriate management. Ultrasound was also useful but to a lesser extent. CT or US guided PAD reduced the surgical operation to a single stage procedure instead of the former 2- to 3-stage surgical management. Plain abdominal x-ray were only useful for the diagnosis in intestinal obstruction and vesical fistula. Contrast enema provided supporting information when necessary. CT clearly diagnosed both suspected and totally unsuspected cases of diverticulitis and provides guidance for the appropriate management. When CT is unavailable US with accurate colonic imaging and abscesses identification can also be useful in diagnosing and guiding drainage. Plain abdominal x-rays are less helpful but mandatory since the presentation is usually that of acute abdomen. Water soluble contrast enema also provides supportive features when necessary. In areas where diverticular disease is uncommon, diverticulitis should be suspected in cases with left iliac fossa or pelvic pain with mass and tenderness.

Association of rectal diverticula and scleroderma.

Barium enema examinations of 7,200 patients were analyzed to determine the presence of rectal diverticula. Five patients with rectal diverticula, a prevalence of 0.07%, were found. Their diameters varied from 10 to 80 mm. Each of the patients had a single rectal diverticulum. Two patients had scleroderma with no other diverticula in the large bowel. None of our patients had symptoms referable to the rectal diverticula.

Diverticular disease of the vermiform appendix and its clinical relevance.

The case of a solitary diverticulum of the appendix found on routine barium enema is presented. The types of diverticula, their presentations and their potential outcomes and significance are discussed.

L N S C3: a proposed classification system for female urethral diverticula.

No descriptive criteria for the preoperative classification of female urethral diverticula have been proposed. Consequently, alternative therapies and different treatment series are not easily compared. Since 1982 the authors have evaluated 61 women with urethral diverticula and have identified those preoperative factors critical to an organized surgical approach to urethral diverticula. From this experience, a simple, comprehensive classification system for female urethral diverticula is proposed. The classification system is called L/N/S/C3. Each letter of the system represents a different characteristic of urethral diverticula. L = Location, the site of the diverticulum, i.e., distal, mid, or proximal urethra, with or without extension beneath the bladder neck. N = Number, whether single or multiple diverticula are present. S = Size, expressed in centimeters (cm). C3 = Configuration, Communication, and Continence Configuration (C1) describes whether we diverticulum is single, multiloculated, or saddle shaped. Communication (C2) indicates the site of communication with the urethral lumen, i.e., distal, mid, or proximal urethra. Continence (C3) is the presence of genuine stress urinary incontinence. Adhering to this format provides the surgeon a systematic means of approaching a urethral diverticulum and thus may minimize postoperative complications. Finally, the authors encourage other surgeons reporting series of urethral diverticula to adopt this system so that standard terminology may allow accurate comparison of surgical results.

Giant colonic diverticulum: an unusual manifestation of a common disease.

Giant colonic diverticula are an uncommon manifestation of colonic diverticular disease. This report documents another case of this rare entity. The clinical presentation is variable, but abdominal pain and the presence of an abdominal mass are common. Their etiology is uncertain, but they are thought to originate from pulsion diverticula. Abdominal plain films and barium enema are helpful in making the diagnosis. Computerized tomography is useful when the diagnosis is unclear. Surgical resection is recommended to alleviate symptoms and avoid complications.

Juxtapapillary duodenal diverticula and diverticula of the colon: is there a general "gastrointestinal diverticular disease"?

Both juxtapapillary duodenal diverticula and colon diverticula are acquired lesions, the pathogenesis of which is believed to involve the influence of high intraluminal pressure on loci minoris resistentiae in the gastrointestinal wall. We wanted to investigate whether juxtapapillary duodenal diverticula and colon diverticula occur independently, or whether they are part of a hypothetical general "gastrointestinal diverticular disease". 239 patients with juxtapapillary duodenal diverticula were identified in 2231 patients undergoing ERCP. Complete radiology data were available in 119/239 patients. Double contrast barium enema had been performed in 28/119 patients. In these patients, colon diverticula were present in 9/20 women and 1/8 men. The frequency of colon diverticula in these patients was compared with randomly chosen age- and sex-matched controls, for whom barium enema results were available. In these controls, 9/20 women and 1/8 men also had colon diverticula (n.s.). We conclude that after stratification for age and sex, the occurrence of colon diverticula is not higher in patients with juxtapapillary duodenal diverticula than in the general population. Juxtapapillary duodenal diverticula and colon diverticula thus occur independently. These data are not in favor of the existence of a general gastrointestinal diverticular disease.

[Diverticula in the vermiform appendix]. / Divertículos en el apéndice vermicular.

A case of multiple appendiceal diverticula seen by barium enema is reported. Five diverticula were clearly demonstrated. The patient was asymptomatic. Most diverticula of the appendix have been found at laparotomy for complicated appendicitis. We believe that prophylactic appendectomy should be performed to prevent complications.

Diverticular disease of the colon in Ibadan, Nigeria.

Eleven cases of diverticular disease of the colon were seen in a review of 603 adult barium enema examinations carried out over a 2-year period (January 1984-December 1985) at the University College Hospital, Ibadan, Nigeria--a prevalence of 1.85%. All the cases were clinically unsuspected and the diagnosis was established only at barium examination. Five of the 11 patients presented with rectal bleeding, six with alteration in bowel habit, six with abdominal pain and associated fever and one with right iliac fossa pain and tenderness mimicking appendicitis. Although an uncommon disease in Nigerians, clinicians are urged to suspect diverticular disease in their differential diagnoses of disorder of the colon in Africans in order not to miss a potentially lethal but treatable condition.

Rectal diverticulosis: a case report and review of the literature.

The occurrence of rectal diverticulosis is rare. We report the incidental finding of a large rectal diverticulum in a patient receiving an air-contrast barium enema. The presence of uncomplicated rectal diverticulosis is probably of little clinical significance. However, there can be associated complications such as inflammation and perforation, and potential confusion with rectal carcinoma.