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.

An unusual presentation of gastric diverticulum: a rare form of diverticulum of the gastrointestinal tract

Report of two cases of gastric diverticulum (GD) documented by upper gastrointestinal contrast radiographic studies and computed tomography (CT).

Imágenes en divertículos del tubo digestivo: localizaciones infrecuentes. serie de casos / Imaging in infrequent digestive diverticula: case series

Los divertículos se pueden localizar en todo el tubo digestivo (TD): esófago, estómago, duodeno, yeyuno, íleon, apéndice, colon. Son infrecuentes, salvo en colon. Sus manifestaciones clínicas son inespecíficas, con difícil diagnóstico y mayor riesgo de complicaciones. Se presenta una serie de divertículos digestivos atípicos, mostrando las características imagenológicas multimodalidad y describir los hallazgos claves. Es una revisión retrospectiva en el archivo computacional de nuestra institución. Selección de casos de divertículos de presentación inhabitual por sus características, localización u origen. En esófago los divertículos de Zenker y Killian-Jamieson. En estómago los divertículos gástricos infrecuentes. Los divertículos en intestino delgado tienen baja prevalencia, el más frecuente en duodeno. Los divertículos colónicos pueden tener una localización o presentación atípica. Los divertículos apendiculares y Meckel presentan baja prevalencia. Los divertículos digestivos son infrecuentes, excepto los colónicos. El radiólogo debe estar familiarizado con las diferentes ubicaciones de ellos, para reconocerlos y poder diagnosticarlos.

Diverticula may occur in any segment of the digestive tract: esophagus, stomach, duodenum, jejunum, ileum, appendix, and colon. Its clinical manifestations are nonspecifi which may turn diffiult an early diagnosis, leading to a higher risk of complications. We present a cases serie of atypical digestive diverticula and to describe the fidings on the different imaging techniques. We performed a retrospective review on the imaging computer archives of our institution. The atypical diverticula were selected. Zenker and Killian-Jamieson's diverticulums in esophagus. In stomach ocasionally gastric diverticula. Diverticula in small intestine have a low prevalence, the most common location is duodenum. Colonic diverticula may present a atypical location or presentation. The appendicular and Meckel diverticuli are uncommon. The digestive diverticula are uncommon, except the colonic ones. The radiologist must be familiar with it's different locations in order to be able to recognize it and diagnose it properly.

Divertículo gástrico: hallazgo inusual en la endoscopia digestiva alta / Gastric diverticulum: an unusual finding in upper gastrointestinal endoscopy

Diverticula may occur throughout the gastrointestinal tract, gastric localization is the most infrequent and these can be: false diverticula, which are less common and typically located in the antrum; and true diverticula, which are more frequent and are located in the posterior wall of the gastric fundus. This is a very rare condition and its prevalence in radiographic studies can be of 0.04 percent, in endoscopy, of 0.01 percent to 0.11 percent, and of 0.1 percent to 2.6 percent in autopsy series. Diagnosis is typically in the fifth and sixth decades. Normally this is an incidental finding in asymptomatic patients, by means of an upper gastrointestinal endoscopy, upper digestive tract ultrasound or computed tomography. Due to low incidence, there is no consensus regarding treatment, however the general practice is that only those patients with symptomatic diverticula must receive medical treatment; and those with diverticula > 4 cm must undergo surgery, due to the risk of inflammation, bleeding, perforation, or malignant transformation, caused by food retention and subsequent release of gastric juices within the mucosal sac. We present the case of two asymptomatic patients who were diagnosed incidentally.

Los divertículos pueden ocurrir a lo largo de todo el tracto gastrointestinal, la localización gástrica es la menos frecuente, pueden ser falsos, que son menos frecuentes y se localizan en el antro gástrico, y verdaderos que son los más frecuentes y se localizan en la pared posterior del fondo gástrico. Se trata de una condición muy rara y su prevalencia en estudios radiográficos puede ser del 0,04 por ciento, en endoscopias del 0,01 por ciento al 0,11 por ciento, y con una prevalencia en series de autopsias del 0,1 al 2,6 por ciento. El diagnóstico se realiza más frecuentemente en la quinta década de la vida. Generalmente, es un hallazgo casual en pacientes asintomáticos, y se realiza mediante endoscopia de vías digestivas altas, radiografía de vías digestivas altas o tomografía computarizada. Debido a la baja incidencia, no existe consenso en cuanto al tratamiento, pero el concepto general es que solo deben ser tratados medicamente los pacientes con divertículos sintomáticos, o mediante cirugía, aquellos con diámetro mayor a 4 cm, dado el riesgo de inflamación, sangrado, perforación, o transformación maligna, debido a la retención de los alimentos con la subsiguiente liberación y retención de los jugos gástricos dentro del saco diverticular. Presentamos el caso de dos pacientes asintomáticos, en quienes se realizó el diagnóstico de forma fortuita.

Imaging findings of gastric diverticula.

INTRODUCTION: Gastric diverticula (GD) are very rare. Computer tomographic findings in GD have been reported only as case reports previously. The aim of this study was to estimate the prevalence of GD on computed tomography (CT) and to analyze their radiological appearances. MATERIALS AND METHODS: From 2006 to 2013, a total of 14,428 patients were examined by abdominal/thoracic CT at our institution. GD were diagnosed in 18 (0.12%) patients (13 women and 5 men, median age, 64 years). In 9 patients, additional endoscopy and in 7 patients upper gastrointestinal investigation with contrast medium were performed. Magnetic resonance imaging (MRI) was available for 3 cases. RESULTS: In all patients GD were diagnosed incidentally during CT examination. The diverticula were located at the posterior wall of the gastric fundus below the esophagogastric junction. On CT, GD presented as cystic lesions with a thin wall and an air fluid level, located behind the stomach between spleen, adrenal gland, and crus of the left diaphragm. CONCLUSION: The prevalence of GD encountered in our CT series is 0.12%. GD demonstrate typical CT appearances, namely, cystic lesions located in the left paravertebral region. The radiologist should be familiar with this finding to avoid possible misinterpretations.

[Laparoscopic resection of gastric diverticula: two case reports]. / Die laparoskopische Resektion von Magendivertikeln: zwei Fallberichte.

Gastric diverticula are rare. In the literature the mentioned incidences vary between 0.01 % and 2.6 % depending on the method of detection. Until now the laparoscopic treatment of gastric diverticula is reported worldwide by eight authors (eight laparoscopic resections and one laparoscopic invagination with oversewing). Between September 2000 and November 2004 we have operated upon two patients laparoscopically for a gastric diverticulum. In two case reports we describe our operative and perioperative procedure. In both cases the gastric diverticulum was resected with a linear stapling device. In the second patient we did simultaneously a laparoscopic 360 degrees -Nissen-fundoplicatio plus dorsal hiatorrhaphy and fundopexy because of reflux disease based on a cardia insufficiency. The dates of the literature concerning incidence, localisation, classifications, symptoms, diagnostic and therapy are summarized and discussed. Our two case reports show, like the cases mentioned in the literature, that symptomatic gastric diverticula can be treated by laparoscopic resection with very good results.

Pouch diverticula after vertical-banded gastroplasty.

PURPOSE: Diverticula of the proximal gastric pouch are rare after vertical-banded gastroplasty (VBG) for morbid obesity. We report the radiographic findings observed in a series of 12 patients with pouch diverticula. MATERIALS AND METHODS: Lesions were found along the posteromedial wall of the proximal gastric pouch and ranged in size from 10 to 25 mm. Only two patients were symptomatic at the time of diagnosis; in most cases, diverticula were discovered during studies performed as part of the standard follow-up protocol. Diverticula were followed up in 7/12 cases, and four showed slight enlargement over a period ranging from 14 to 53 months. RESULTS: The presence of diverticula was not correlated with symptoms, postoperative weight loss, or clinical history, and no differences in long-term complications were demonstrated between VBG patients with diverticula and those without them. CONCLUSIONS: We do not believe these lesions to be clinically important; at present, our patients are no longer followed up for this problem and undergo diagnostic examinations only if and when they develop symptoms.

Commonly encountered adrenal pseudotumours on CT.

There are a variety of causes of adrenal pseudotumours on CT, including gastric diverticulum, prominent splenic lobulation, upper-pole renal mass, pancreatic mass, hepatic mass and periadrenal varices. These adrenal pseudotumours can be elucidated by multiplanar reconstruction using CT and MRI as well as from the axial images.

[Clinical evaluation of gastric diverticulum on indirect radiograph for gastric mass survey].

The aim of this study was to evaluate the clinical conditions of gastric diverticulum. Fifty-four patients with gastric diverticulum (20 men and 34 women among 34,314 patients who underwent medical check-ups) were evaluated on indirect radiographs, for an incidence of 0.16% among the total number of examined cases, a rate lower than that of previous reports. Almost all cases were asymptomatic, had a single diverticulum, and showed a saccular shape. The age distribution indicated higher frequencies in the 5th and 6th decades, and the posterior wall of the fornix was the most common location. Size ranged from 0.6 cm to 12 cm, and 41 cases (75.9%) were between 1.0 cm and 4.0 cm in size. This entity should be kept in mind when reading radiographs of upper gastrointestinal series as well as recognition of pseudodiverticulum and aberrant pancreas as noted for the stomach in several past report. Diverticulum on the cardia, which was previously classified as gastric diverticulum, should be excluded because of the possibility of normal variation.