[Trust, but verify]. / Vertrauen ist gut ­ Kontrolle ist besser.

We report the case of a 39-year-old woman with a gastric diverticulum misdiagnosed as a left adrenal lesion on computed tomography imaging.

Ventricular diverticula formation in captive parakeet auklets (Aethia psittacula) secondary to foreign body ingestion.

A captive parakeet auklet at the North Carolina Zoo evaluated for weight loss, lethargy, and dyspnea had radiographic evidence of a distended, stone-filled ventriculus (bird 1). Multiple stones (n = 76) were removed surgically, but the bird died and a large ventricular diverticulum was diagnosed at necropsy. This bird and seven other parakeet auklets had been transferred 3 yr earlier from a zoo in Ohio. Radiographic investigation revealed that 6 of 7 Ohio birds had stones in their ventriculus (n= 2-26), but only 1 of 7 radiographed North Carolina Zoo auklets had one small stone. Further diagnostic imaging (survey and contrast radiographs, fluoroscopy, CT scans [n = 2]) of six Ohio and two North Carolina birds was conducted to determine if other birds had ventricular abnormalities (birds 2-9). No ventricular diverticula were diagnosed using imaging techniques, although two Ohio birds (birds 6 and 7) required surgical intervention to remove 12-26 stones. A small ventricular diverticulum was identified in bird 6 during surgery. That bird died of unrelated causes 11 mo after surgery, but bird 7 remains clinically normal more than 4 yr later, along with four other auklets with stones (n = 2-15; birds 2-5). It is possible that without surgical intervention, these birds may develop ventricular disease, presumably due to chronic mechanical trauma to the thin-walled ventriculus. It was hypothesized that the Ohio birds ingested stones in their previous exhibit, with a loose stone substrate, and retained them for at least 3 yr. Possible causes for stone ingestion include trituration (for grinding, mixing coarse ingesta), gastric parasite reduction, hunger suppression, accidental ingestion while feeding, or behavioral causes, but the underlying cause in these birds was not determined. Based on these results, parakeet auklets and other alcids should not be housed, or at least fed, on a loose stone substrate.

A disconcerting false gastric diverticulum mimicking malignancy.

Gastric diverticula are the most uncommon form of gastrointestinal diverticula. They can either be of true or false type with different pathogenesis. They may be very challenging to diagnose as symptoms are nonspecific and imaging can simulate a malignant lesion. We report an unusual case of pre-pyloric diverticulum in a 69-year-old man, leading to severe gastric obstruction with a poor general condition. As subsequent endoscopy and imaging were alarming and couldn't exclude malignancy, the patient underwent an antrectomy. The final diagnosis was made on pathological examination. We discuss, through this case, the clinical and pathological features of gastric diverticula with an emphasis on the pathogenesis of this rare entity and the risk of a malignant transformation.

Gastric diverticulum simulating left adrenal incidentaloma in a hypertensive patient.

A 46-year-old Japanese male with hypertension was referred for examination of left adrenal tumor incidentally detected by computed tomography (CT) scan. The patient had a 4-month history of hypertension. Abdominal CT demonstrated a low-density mass 2.5 cm in diameter in the left adrenal region that was observed as a high-intense lesion with T2-weighted magnetic resonance imaging. (131) I-adosterol scintigraphy showed normal uptake of bilateral adrenals. The adrenocortical hormone levels were within normal ranges; however, urinary noradrenaline excretion was slightly elevated, likely due to concurrent sleep apnea syndrome. Based on the observation of a very tiny bubble in the ventral portion of the adrenal mass by careful review of CT images examined at a previous hospital, a restudy of abdominal CT with oral contrast was performed. In this restudy abdominal CT we observed positive enhancement of the left adrenal mass, indicating that the adrenal mass was a diverticulum derived from posterior gastric fornix. The present case study reinforces that preoperative differentiation from mimic adrenal tumors is necessary in cases of cystic adrenal mass in the left adrenal region.

[Comparative evaluation of the sensitivity to the carcinogenic action of N-methyl-N'-nitro-N-nitrosoguanidine of the epithelium of endophytic adenomatous-hyperplastic structures and of the epithelium of the gastric glands in rats]. / Sravnitel'naia otsenka chuvstvitel'nosti k kantserogennomu deistviiu N-metil-N'-nitro-N-nitrozoguanidina épiteliia éndofitnykh adenomatozno-giperplasticheskikh struktur i épiteliia zhelez zheludka krys.

The experiments carried on 107 rats have shown that the sensitivity of the epithelium of experimental adenomatous diverticuli of the stomach to the action of N-methyl-N'-nitro-N-nitrosoguanidine is lower than that of the gland epithelium of the organ.

Multiple gastric diverticulosis: report of a case.

A case of multiple gastric diverticula with pyloric stenosis is reported here. More than 30 diverticula were located throughout the stomach except in the pyloric antrum. The diverticula were divided into two types according to shape: shallow depression and mushroom-like outpouching. This case has the greatest number of gastric diverticula ever reported.

[Congenital cystic duplication of the stomach--a rare surgical disease]. / Die congenitale cystische Duplikatur des Magens--eine seltene chirurgische Erkrankung.

Duplication of the stomach is a rare congenital disease of the childhood. We report the exceptional manifestation in two adults. The clinical presentation and developmental theory is discussed by reviewing the literature. Today the therapy of choice is resection of the duplication with removal of the adjacent wall of the stomach.

[Stomach diverticulum. A case report]. / Diverticolo gastrico. Descrizione di un caso.

The author reports a case of gastric symptomatic diverticulum, not connected to other gastric-biliary-duodenal pathology. The author points out the rarity of diverticulum of the alimentary canal, and points out the symptomatic picture that, in association with a radiologically ascertained diverticulum staunching, represent indications for surgery.

Visualisation of diverticula of the upper part of the alimentary tract; comparison of roentgenologic and endoscopic techniques.

Diverticula of the upper part of the alimentary tract, irrespective of their etiology, are frequently observed benign changes of the pharynx, oesophagus, stomach and duodenum. In the present work, patients of the II General Surgery Department of the Medical University of Lublin, with radiologically or endoscopically proved diverticula of the upper part of the alimentary tract, were examined. The presence of diverticula of such localisation was an indication for supplementary endoscopic or radiological examination. The localisation, size, diameter of the opening, mucosal relief of diverticula and its contiguity were checked and analysed. Our data suggest that both medical procedures are complementary to each other. All previously observed changes in diverticula of the thoracic part of the oesophagus and the infradiaphragm part of the alimentary tract were fully proved. The radiological examination gave a better view of Zenker's diverticulum, especially in short and obese patients. Sampling and better visualisation of the diverticula opening testify to the unquestionable superiority of endoscopy. However, precise evaluation by radiological process fully completes the diagnostic protocol. Both diagnostic procedures are usually supplemented by manometric examination of the oesophagus and superior and inferior oesophageal sphincters. This enables the accurate diverticula etiology to be stated.

Visualisation of diverticula of the upper part of the alimentary tract; comparison of roentgenologic and endoscopic techniques.

Diverticula of the upper part of the alimentary tract, irrespective of their etiology, are frequently observed benign changes of the pharynx, oesophagus, stomach and duodenum. In the present work, patients of the II General Surgery Department of the Medical University of Lublin, with radiologically or endoscopically proved diverticula of the upper part of the alimentary tract, were examined. The presence of diverticula of such localisation was an indication for supplementary endoscopic or radiological examination. The localisation, size, diameter of the opening, mucosal relief of diverticula and its contiguity were checked and analysed. Our data suggest that both medical procedures are complementary to each other. All previously observed changes in diverticula of the thoracic part of the oesophagus and the infradiaphragm part of the alimentary tract were fully proved. The radiological examination gave a better view of Zenker's diverticulum, especially in short and obese patients. Sampling and better visualisation of the diverticula opening testify to the unquestionable superiority of endoscopy. However, precise evaluation by radiological process fully completes the diagnostic protocol. Both diagnostic procedures are usually supplemented by manometric examination of the oesophagus and superior and inferior oesophageal sphincters. This enables the accurate diverticula etiology to be stated.

[Suppression of a subcardial diverticulum of the stomach]. / Suppression d'un diverticule sous-cardial de l'estomac.

A case of subcardial gastric diverticulum was surgically treated by an original technique which provided good exposure of the lesion and made it possible to sever all adhesions between the diverticulum and adjacent organs. This technique avoids gastrotomy and partial gastric resection.

[CT and MRI features of a pseudo adrenal lesion: subcardial diverticulum]. / Aspects TDM et IRM d'une pseudo lésion surrénalienne: le diverticule sous-cardial.

Gastric diverticula are rare. The retroperitoneal site of subcardial diverticula may be suggestive of a left adrenal mass on CT and MR. The authors report two cases. Radiological demonstration of a communication with the stomach confirms the diagnosis.

Gastric diverticula.

The cases of three patients with a gastric diverticulum are described and the symptoms, diagnosis and treatment are reviewed.