A case report of large gastric diverticulum with literature review.

INTRODUCTION: A gastric diverticulum is a rare form of diverticular disease due to outpouching of the gastric wall. It is equally presented within both sexes and commonly occurs in fifth and sixth decades of life. Patients mostly asymptomatic but may present with mild gastric symptoms. Surgical treatment is largely dependent on the patient's symptoms, and a laparoscopic approach is usually recommended for surgery. CASE PRESENTATION: A 77-year-old gentleman presented to the outpatient clinic with a one-month history of passing black stools. He was arranged for an oesophagogastroduodenoscopy (OGD) which revealed a gastric body polyp and a diverticulum in the fundus of the stomach. DISCUSSION: Gastric diverticulum is defined as an outpouching of the gastric wall. They are uncommon, with an incidence between 0.01-0.11%. Predisposing factors include: areas of weakness caused by splitting of the longitudinal muscle fibres, an absence of peritoneal membrane and perforating arterioles. The management of patients with gastric diverticulum depend largely on their symptoms. There is no specific treatment required for an asymptomatic diverticulum. CONCLUSION: Gastric diverticula are rare conditions which are largely asymptomatic but may present with varying signs and symptoms and may require surgical intervention.

Unexpected histopathology of acute appendicitis.

INTRODUCTION: Appendicular diverticula and associated diverticulitis is a rare disease. Patients present commonly with symptoms of acute appendicitis and require laparoscopic or open surgery. Diagnosis is usually made only on histology. Here, we present a rare case of acute diverticulitis of the appendix. CASE PRESENTATION: A 33-year old gentleman presented with right iliac fossa pain of 3 days duration. On admission, appendicitis was diagnosed on Computerized Tomography (CT) scan and laparoscopic appendicectomy was subsequently performed. Intra-operative findings were unremarkable and recovery was uneventful. Histopathology however revealed diverticulitis of appendix with acellular mucin. DISCUSSION: Acute diverticulitis of the appendix is an exceptionally rare condition and reported in 0.004%-2% of appendicectomies. It presents usually when complicated with perforation and bleeding. There is however a strong association with certain malignancies such as mucinous neoplasm, carcinoid and Pseudomyxoma peritoneii. Radiological proven appendicular diverticulum requires early intervention due to higher chance of diverticulitis related complication. Surgeons should be aware about this rare disease and may consider elective surgery in view of potential risk of complications and malignancy. CONCLUSION: We concluded that because of strong malignant association, it would be recommended that all appendix specimens should inspect during and after surgery and concurrent examination of peritoneal cavity is recommended.