Treatment of uterine scar cystoid diverticulum by hysteroscopy combined with laparoscopy.

OBJECTIVE: To report a patient with prolonged intermenstrual bleeding and a cystic mass at a cesarean scar treated with laparoscopic folding sutures and hysteroscopic canalization. DESIGN: A 4.0 cm-cystic mass formed at the uterine scar caused continuous menstrual blood outflow in the diverticulum and was treated with hysteroscopy combined with laparoscopy. SETTING: University hospital. PATIENTS: A 38-year-old woman of childbearing age who had undergone two cesarean sections and two abortions reported vaginal bleeding for 10 years, which began shortly after the second cesarean section. Curettage was performed, but no abnormality was found. The patient unsuccessfully tried to manage her symptoms with traditional Chinese medicine and hormone drugs. The muscular layer of the lower end of the anterior wall of the uterus was weak, and there were cystic masses on the right side. INTERVENTION: The bladder was stripped from the lower uterine segment under laparoscopy, and the surrounding tissue of the mass at the uterine scar was separated. The position of the cesarean scar defect was identified by hysteroscopy combined with laparoscopy, and the relationship between the uterine mass and surrounding tissues was analyzed. An electric cutting ring resection on both sides of the obstruction was performed to eliminate the valve effect. The active intima of the scar diverticulum was destroyed by electrocoagulation, followed by laparoscopic treatment of the uterine scar diverticulum mass. An intraoperative tumor incision revealed visible bloody fluid mixed with intimal material. The uterine scar diverticulum defect was repaired using 1-0 absorbable barbed continuous full-thickness mattress fold sutures. Finally, the bilateral round ligament length was adjusted so that the uterus tilted forward. MAIN OUTCOME MEASURES: Recovery of menstruation and anatomy of the uterine isthmus. RESULTS: The operation was successful, and the postoperative recovery was fast. There was no interphase bleeding at the 1-month follow-up, and the uterine scar diverticulum was repaired, with the thickness of the uterine scar muscle layer increasing to 0.91 cm. CONCLUSION: The simple, straightforward procedure to resolve the abnormal cystic, solid mass formed because of the continuous deposition of blood in the uterine scar diverticulum involved laparoscopic folding and docking sutures combined with hysteroscopic canal opening.

An elderly male with lower urinary tract symptoms during COVID-19 pandemic: Extraperitoneal perforation of bladder diverticulum.

CASE: We present a case of spontaneous extra-peritoneal rupture of an acquired diverticulum an elderly male with symptoms of bladder outlet obstruction who presented in emergency with acute abdomen. OUTCOME: The acute phase was managed conservatively with bladder drainage and intravenous antibiotics. He recently underwent Transurethral Resection of Prostate. He is asymptomatic on follow-up. CONCLUSIONS: Acquired bladder diverticulum are rare in adults and are mostly seen in patients with high pressure bladder due to bladder outlet obstruction. Atraumatic extraperitoneal ruptures of diverticulum are uncommonly reported.

Large bladder diverticula: a comparison between laparoscopic excision and endoscopic fulguration.

OBJECTIVE: The treatment of bladder diverticula consists of diverticulectomy, mainly by a laparoscopic approach or transurethral resection of the diverticular neck and fulguration of the mucosa. The endoscopic approach is generally dedicated to small diverticula. The aim of this study was to compare laparoscopic diverticulectomy versus endoscopic fulguration for bladder diverticula larger than 4 cm. MATERIALS AND METHODS: A retrospective review of the medical records of consecutive patients undergoing endoscopic or laparoscopic treatment for bladder diverticula larger than 4 cm at two tertiary hospitals was performed. Therapeutic success was defined as either complete resolution or a decrease of at least 80% in the size of the diverticulum. Complications were recorded and graded according to the Clavien-Dindo classification. RESULTS: All patients were treated with transurethral resection of the prostate in the same operative session. The endoscopic group included a cohort of 20 male patients. The median age, diverticular diameter and operative time were 65 years, 7 cm and 62.5 min, respectively. No early postoperative complications were observed. Therapeutic success was achieved in 15 cases (75%). The laparoscopic group included a cohort of 13 male patients with a median age of 63 years and median diverticular diameter of 7.0 cm. The median operative time was 185 min (p < 0.0001). Two grade III postoperative complications were observed (15.3%). Therapeutic success was achieved in all patients (100%). CONCLUSIONS: Acquired bladder diverticula larger than 4 cm can be effectively managed either by a laparoscopic approach or by endoscopic fulguration.

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.

Sequential transurethral enucleation of the prostate and laparoscopic bladder diverticulectomy.

Transurethral endoscopic technique and standard laparoscopic technique are surgical options for the management of benign prostatic hyperplasia (BPH) associated with urinary bladder diverticuli (UBD). In this article, we report laparoscopic diverticulectomy (LD) and transurethral plasmakinetic enucleation of the prostate (TUEP) in the same patient sequentially. To the best of our knowledge, this is the first case report of LD combined with TUEP. An 82-year-old patient with benign prostatic hyperplasia and two secondary large bladder diverticuli underwent sequential TUEP and LD. After completion of the TUEP procedure, the detached adenoma was pushed into the bladder as a whole. Then laparoscopic transperitoneal extravesical diverticulectomy assisted by cystoscopic transillumination was performed immediately, and the enucleated prostate was removed via the neck of the diverticulum. The enucleation time and diverticulectomy time was 18 minutes and 108 minutes, respectively. The catheter was removed on the tenth postoperative day. Transurethral endoscopic surgery combined with LD is a good choice in treating BPH and UBD in one session. But the combined procedure is time-consuming, especially for fragmentation of the prostate. TUEP can greatly reduce the operative time of the combined procedure.

Characteristics and outcome of congenital left ventricular aneurysm and diverticulum: Analysis of 809 cases published since 1816.

BACKGROUND: Congenital left ventricular aneurysm (LVA) or diverticulum (LVD) is rare cardiac anomalies. We aimed to analyse the clinical characteristics and outcome in all ever published patients. METHODS: MEDLINE, Web of science, Google and EMBASE, and reference lists of relevant articles were searched for publications reporting on LVA or LVD patients. RESULTS: We identified 809 patients published since 1816 [354 (49.1%) LVA, 453 (50.6%) LVD, 2 (0.3%) both]. Mean age at diagnosis was 34.1±27 (LVA) and 29.7±27.6years (LVD; p=0.05). 48.9% were male. LVA was larger (38.7±22.5mm versus 31.4±21.2mm; p=0.002) and frequently found in submitral location (33% versus 4.9%; p<0.001), LVD was frequently located at the LV-apex (61.2% versus 28.7%; p<0.001). LVD was often associated with cardiac (34.2% versus 11%; p<0.001) or extracardiac anomalies (32.7% versus 3%; p<0.001). LVA patients presented more frequently with ventricular tachycardia/fibrillation (18.1% versus 13.1%; p=0.01), the incidences of rupture (4% versus 4.5%; p=0.9), syncope (8.3% versus 5.1%; p=0.1), and embolic events (4.9% versus 3.6%; p=0.4) at presentation were not different between LVA and LVD. Mean follow-up was 56.3±43months. Cardiac death occurred more frequently in the LVA group (11.5% versus 5.0%; p=0.05) at a median age of 0.8 [LVA] and 2.5 [LVD] years. The leading cause of cardiac death was congestive heart failure in the LVA-group (50.0% versus 0.0%; p=0.01), and rupture in the LVD-group (75.0% versus 27.3%; p=0.04). CONCLUSIONS: LVA and LVD are distinct congenital anomalies with different clinical and morphological characteristics. The prognosis of LVA is significantly worse during long-term follow-up.

Diverticulum of the third ventricle and absence of the interthalamic adhesion in a dog.

A 10-month-old male Pomeranian dog was examined for neurological abnormalities consistent with diffuse forebrain and cerebellar disease. Based on ultrasound and magnetic resonance imaging (MRI) a diagnosis of diverticulum of the third ventricle, partial agenesis of the corpus callosum, and absence of the interthalamic adhesion was made. As conservative treatment was unsuccessful, a ventriculoperitoneal shunt was placed.

Complicated diverticular disease: the changing paradigm for treatment.

The term "complicated" diverticulitis is reserved for inflamed diverticular disease complicated by bleeding, abscess, peritonitis, fistula or bowel obstruction. Hemorrhage is best treated by angioembolization (interventional radiology). Treatment of infected diverticulitis has evolved enormously thanks to: 1) laparoscopic colonic resection followed or not (Hartmann's procedure) by restoration of intestinal continuity, 2) simple laparoscopic lavage (for peritonitis +/- resection). Diverticulitis (inflammation) may be treated with antibiotics alone, anti-inflammatory drugs, combined with bed rest and hygienic measures. Diverticular abscesses (Hinchey Grades I, II) may be initially treated by antibiotics alone and/or percutaneous drainage, depending on the size of the abscess. Generalized purulent peritonitis (Hinchey III) may be treated by the classic Hartmann procedure, or exteriorization of the perforation as a stoma, primary resection with or without anastomosis, with or without diversion, and last, simple laparoscopic lavage, usually even without drainage. Feculent peritonitis (Hinchey IV), a traditional indication for Hartmann's procedure, may also benefit from primary resection followed by anastomosis, with or without diversion, and even laparoscopic lavage. Acute obstruction (nearby inflammation, or adhesions, pseudotumoral formation, chronic strictures) and fistula are most often treated by resection, ideally laparoscopic. Minimal invasive therapeutic algorithms that, combined with less strict indications for radical surgery before a definite recurrence pattern is established, has definitely lead to fewer resections and/or stomas, reducing their attendant morbidity and mortality, improved post-interventional quality of life, and less costly therapeutic policies.

Complicated diverticular disease: the changing paradigm for treatment / Doença diverticular complicada: alterando o padrão de tratamento

The term "complicated" diverticulitis is reserved for inflamed diverticular disease complicated by bleeding, abscess, peritonitis, fistula or bowel obstruction. Hemorrhage is best treated by angioembolization (interventional radiology). Treatment of infected diverticulitis has evolved enormously thanks to: 1) laparoscopic colonic resection followed or not (Hartmann's procedure) by restoration of intestinal continuity, 2) simple laparoscopic lavage (for peritonitis +/- resection). Diverticulitis (inflammation) may be treated with antibiotics alone, anti-inflammatory drugs, combined with bed rest and hygienic measures. Diverticular abscesses (Hinchey Grades I, II) may be initially treated by antibiotics alone and/or percutaneous drainage, depending on the size of the abscess. Generalized purulent peritonitis (Hinchey III) may be treated by the classic Hartmann procedure, or exteriorization of the perforation as a stoma, primary resection with or without anastomosis, with or without diversion, and last, simple laparoscopic lavage, usually even without drainage. Feculent peritonitis (Hinchey IV), a traditional indication for Hartmann's procedure, may also benefit from primary resection followed by anastomosis, with or without diversion, and even laparoscopic lavage. Acute obstruction (nearby inflammation, or adhesions, pseudotumoral formation, chronic strictures) and fistula are most often treated by resection, ideally laparoscopic. Minimal invasive therapeutic algorithms that, combined with less strict indications for radical surgery before a definite recurrence pattern is established, has definitely lead to fewer resections and/or stomas, reducing their attendant morbidity and mortality, improved post-interventional quality of life, and less costly therapeutic policies.

O termo diverticulite "complicada" é reservado para a doença diverticular complicada por sangramento, abscesso, peritonite, fístula ou obstrução intestinal. A hemorragia é melhor tratada por angioembolização (radiologia intervencionista). O tratamento de diverticulite infectada evoluiu enormemente graças a: 1) ressecção laparoscópica do cólon seguida ou não (procedimento de Hartmann) pelo restabelecimento de continuidade intestinal, 2) lavado laparoscópico simples (peritonite + / - ressecção). A diverticulite (inflamação) pode ser tratada somente com antibióticos, anti-inflamatórios, combinados com repouso e medidas de higiene. O abscesso diverticular (Hinchey graus I, II) pode ser inicialmente tratado somente com antibióticos e / ou drenagem percutânea, dependendo do tamanho do abcesso. A peritonite purulenta generalizada (Hinchey III) pode ser tratada pelo clássico procedimento Hartmann, pela exteriorização da perfuração, como se fosse um estoma, pela ressecção primária com ou sem anastomose, com ou sem desvio do trânsito e, por último, a simples lavagem laparoscópica, geralmente, sem drenagem. A peritonite por fezes (Hinchey IV), uma indicação para o tradicional procedimento de Hartmann, também pode se beneficiar da ressecção primária seguida de anastomose, com ou sem desvio e lavagem laparoscópica. A obstrução aguda (inflamação local, ou aderências, formação pseudotumoral, estenoses crônicas) e fístula são, na maioria das vezes, tratadas por ressecção, preferencialmente, laparoscópica. Algoritmos terapêuticos pouco invasivos combinadas com indicações menos rigorosas para a o emprego da cirurgia radical antes de um padrão definido de recorrência, estão estabelecidos, ocasionando um número menor de ressecções e / ou estomas, reduzindo a morbidade e a mortalidade, melhorando a qualidade de vida após a intervenção, e geram uma tratamento menos dispendioso.

Divertículo de la tercera porción del duodeno: presentación de un caso y revisión de la literatura / Diverticulum in the third portion of the duodenum: case report and review of the literature

Introducción: el duodeno representa el segundo sitio más común de desarrollo de divertículos, después del colon. Se encuentran generalmente a 2,5 cm de la ampolla de Vater o en la primera porción duodenal, en casos relativamente raros, se presentan en la tercera y cuarta porción duodenal. Objetivo: presentación de un caso de divertículo en tercera porción duodenal, así como también la metodología diagnóstica y terapéutica para resolverlo. Discusión: el diagnóstico clínico de los divertículos duodenales presenta dificultad debido a que no existe una presentación clínica característica. Sólo el 10% y 25% de los pacientes son sintomáticos. Las manifestaciones clínicas se desarrollan por las complicaciones de las diverticulitis. El diagnóstico se basa en los estudios contrastados como las seriadas esofagogastroduodenales, TAC multicorte, así como también, la realización de una endoscopía, deben contribuir a un diagnóstico acertado. El tratamiento quirúrgico de los divertículos asintomático en pacientes adultos no está justificado, mientras que en el paciente con síntomas el criterio es quirúrgico para evitar complicaciones como: hemorragia, perforación, diverticulitis, pancreatitis y obstrucción. Conclusión: el tratamiento de los divertículos duodenales varía según el tipo, localización y extensión del proceso inflamatorio. La cirugía se encuentra reservada en un 1 al 3% de los pacientes con divertículos duodenales en tercera porción, considerando aquellos enfermos con dolor abdominal persistente o complicaciones asociadas a la diverticulitis.

Introduction: The duodenum is the second most common site of diverticula development after the colon. They are usually found to 2.5 cm of the ampulla of Vater or the first part of the duodenum, in relatively rare cases, occur in the third and fourth duodenal portion. Objective: A case of duodenal diverticulum in the third portion, as well as diagnostic and therapeutic methodology to solve it. Discussion: The diagnosis of duodenal diverticula have difficulty because there is no characteristic clinical presentation. Only 10% and 25% of patients are symptomatic. The clinical manifestatiions are developed by the complications of diverticulitis. The diagnosis is bases on serial contrast studies such as upper GI, multislice CT, and also carrying out an endoscopy, should contribute to an accurate diagnosis. Surgical treatment of asymptomatic diverticula in adult patients is not justified, whereas in patients with symptoms on surgical approach is to avoid complications such as bleeding, perforation, diverticulitis, pancreatitis and obstruction. Conclusion: The treatment of duodenal diverticula varies according to the type, location and extent of the inflammatory process. Surgery is reserved on a 1 to 3% of patients with duodenal diverticula in the third portin, whereas those patients with persistent abdominal pain or complications associated with diverticulitis.

Rectal diverticulum: a new complication of STARR procedure for obstructed defecation.

We report a case of rectal diverticulum developed after stapled transanal rectal resection (STARR) procedure for obstructed defecation. A 21-year-old woman with chronic constipation was diagnosed with a rectocele at defecography. The patient underwent STARR procedure. Six months later, she presented with severe constipation requiring enemas and a worse condition than that preoperatively. Defecography and rectoscopy revealed a rectal wall diverticulum cavity with incomplete elimination of barium enema. The patient underwent transanal diverticulectomy and direct rectal wall repair. STARR procedure can produce new and difficult-to-treat complications and should be reserved for expert colorectal surgeons with proved familiarity in transanal surgery.

Bladder diverticulum arising adjacent to an ectopic ureter presenting as a cystic mass.

Acquired bladder diverticula due to bladder outlet obstruction are not uncommon in the adult male population. Congenital diverticula originate adjacent to the trigone and are rarely diagnosed in adults. We report an unusual case of a diverticulum arising adjacent to an ectopic ureter located on the left lateral wall near the dome of the bladder. Although the diverticulum appeared to be congenital, its large size was likely a result of high pressure voiding. The patient underwent a transurethral resection of the prostate to reduce his bladder outlet obstruction, and subsequently underwent an open diverticulectomy.

Giant sigmoid diverticulum: case report and review of the literature.

Giant colonic diverticulum is a rare entity first described in 1946 by Bonvin and Bonte. It may be congenital or acquired and the average age of presentation is 65. There are less than 150 reported cases in the literature. A large abdominal mass was detected during a routine physical examination in an 82-year-old man. CT scan showed a large air-filled mass, barium enema showed multiple sigmoid diverticula, but no communication with the mass was found. A diagnosis of giant sigmoid diverticulum was made, elective sigmoidectomy and resection of the diverticulum was performed with no complications. The clinical picture may be different, varying from asymptomatic to acute abdomen, intestinal perforation or fistula. It can be diagnosed with abdominal X-ray, CT scan, barium enema or MRI, but colonoscopy is not effective. There are two accepted theories of the pathophysiology of this entity: first, a congenital origin and second, that inflammatory diverticula are caused by a perforation with a ball-valve that allows gas to enter, but not to leave the cyst, thus, enlarging the false diverticulum, and progressively destroying the bowel layers, causing secondary fibrosis. Elective treatment is a segmental resection of the affected colon with the diverticulum and in cases of acute abdomen two-stage bowel resection is preferred.

Robotic assisted laparoscopic bladder diverticulectomy.

PURPOSE: Surgical management for bladder diverticuli includes open, endoscopic and standard laparoscopic techniques. To our knowledge we report the first series of robotic assisted laparoscopic bladder diverticulectomies. MATERIALS AND METHODS: Five patients underwent robotic assisted laparoscopic bladder diverticulectomy between December 2004 and December 2006, as performed by a single surgeon using the da Vinci robotic system for symptomatic diverticuli. The records were reviewed, the surgical technique is described and a review of the literature was performed. RESULTS: All patients underwent cystoscopy, ureteral stent placement and placement of an angiographic catheter to distend the diverticulum. The diverticulum was approached transperitoneally, mobilized and transected at its neck, and the bladder was closed in 2 layers. One patient underwent ureteral reimplantation for a Hutch diverticulum. Median total operative time was 178 minutes (range 163 to 235) and robotic operative time was 83 minutes (range 63 to 143). Length of stay was 3 days (range 1 to 6). Two patients who underwent transurethral prostate resection before diverticulum resection did well. Two patients in whom medical management failed ultimately underwent transurethral prostate resection and 1 patient continued on medical therapy with regular followup. CONCLUSIONS: Robotic assisted laparoscopic bladder diverticulectomy is safe and effective for patients with a large bladder diverticulum and small prostate. Perioperative surgical outcomes rival those of previously reported open, endoscopic and laparoscopic diverticulectomies.

Is laparoscopic bladder diverticulectomy after transurethral resection of the prostate safe and effective? Comparison with open surgery.

PURPOSE: In a retrospective nonrandomized study, we compared our experience with transurethral resection of the prostate (TURP) plus sequential laparoscopic bladder diverticulectomy with a series of combined open bladder diverticulectomies with transvesical prostatectomy. PATIENTS AND METHODS: We considered 12 consecutive patients (group A) having 16 diverticula who underwent sequential TURP and transperitoneal laparoscopic bladder diverticulectomy and 13 consecutive patients (group B) having 13 diverticula who underwent open bladder diverticulectomy and transvesical prostatectomy. We evaluated the size and position of the diverticulum, adenoma volume, operative time, postoperative hemoglobin variations, analgesia requirement, complications, postoperative hospital stay, and uroflowmetry results. RESULTS: No statistically significant differences existed between the groups in adenoma volume or diverticulum size or position. However, a significantly longer operative time was recorded in group A. The endolaparoscopic approach proved to be statistically superior to open surgery regarding blood loss, postoperative analgesia requirement, and hospital stay. No intraoperative complications were recorded. In addition, no statistically significant difference was found in uroflowmetry results. CONCLUSIONS: In our experience, the endolaparoscopic approach has proved to be safe, effective, and minimally invasive and therefore superior to transvesical prostatectomy and open bladder diverticulectomy. Its only disadvantage is the longer operative time.

Sequential transurethral resection of the prostate and laparoscopic bladder diverticulectomy: comparison with open surgery.

OBJECTIVES: To compare our experience with transurethral resection of the prostate and sequential laparoscopic bladder diverticulectomy with a previous series of combined open bladder diverticulectomy and transvesical prostatectomy. METHODS: We compared the data of 10 consecutive patients (group 1) who underwent sequential transurethral resection of the prostate and transperitoneal laparoscopic bladder diverticulectomy and 13 consecutive patients (group 2) who underwent traditional combined open bladder diverticulectomy and transvesical prostatectomy. The following parameters were considered: size and position of the diverticulum, transrectal ultrasound adenoma volume, operative time, postoperative hemoglobin variations, analgesic requirement, complications, postoperative hospital stay, and urinary flowmetry. RESULTS: No statistically significant differences existed between the two groups either for diverticulum size (6.8 versus 7.2 cm) or diverticula position. A significant difference was observed in the operative time (247 minutes for group 1 versus 136 minutes for group 2, P <0.0001), mean postoperative hemoglobin decrease (2.6 g/dL for group 1 and 3.9 g/dL for group 2, P = 0.001), analgesic requirement (1.3 ampoules of buprenorphine cloritrate for group 1 versus 1.8 ampoules for group 2, P = 0.45), and postoperative hospital stay (3 days for group 1 versus 9.6 days for group 2, P <0.0001). No statistically significant difference was recorded for control flowmetry. No intraoperative complications were recorded for the two groups. CONCLUSIONS: In our series, sequential transurethral resection of the prostate and transperitoneal laparoscopic diverticulectomy for large diverticula proved to be a safe, effective, and minimally invasive procedure, despite the longer operative times compared with transvesical prostatectomy and open bladder diverticulectomy.

[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.

Divertículo gigante de sigma: presentación de un caso y consideraciones sobre el manejo de esta rara complicación de la enfermedad diverticular / Giant sigmoid diverticulum

Presentamos un nuevo caso de esta entidad clínica, diagnosticado en el contexto de un cuadro séptico, con descompensación hidrópica de una cirrosis latente, fistulizado a íleon y tratado con drenajes percutáneos. El divertículo gigante de colon es una rara complicación de la enfermedad diverticular. La presentación clínica es variable, soliendo cursar con dolor y/o con masa abdominal. Aunque su etiología permanece especulativa, parece en relación con un mecanismo de pulsión en el divertículo. La radiografía simple de abdomen, el enema opaco y la tomografía axial computarizada ayudan al diagnóstico. La resección quirúrgica es el tratamiento de elección. Nuestro caso es el primero publicado tratado conservadoramente mediante drenajes percutáneos, dada la muy precaria situación clínica de la paciente (AU)