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Current Gastroenterology Reports Jan 2020Small bowel diverticulosis is a well-known clinical entity whose diagnosis and management has evolved in recent years. This review covers pathophysiology, incidence, and... (Review)
Review
PURPOSE OF REVIEW
Small bowel diverticulosis is a well-known clinical entity whose diagnosis and management has evolved in recent years. This review covers pathophysiology, incidence, and prevalence, and it also provides an update on modern diagnosis and management. Meckel's diverticula are covered elsewhere in this volume.
RECENT FINDINGS
CT scan and MRI have largely supplanted barium follow-through for diagnosis. No intervention is needed in asymptomatic individuals. Endoscopic management is playing an increasing role for both bleeding and resection of intraduodenal diverticula, but surgical intervention remains the only definitive intervention for other complications like diverticulitis and small bowel obstruction. Small bowel diverticulosis is an uncommon condition which is associated with numerous possible complications. While endoscopy is playing an increasingly large role in management, surgical resection remains the treatment of choice for most complications. A high index of suspicion is needed in order to diagnose this entity.
Topics: Diverticulum; Humans; Intestinal Diseases; Intestine, Small
PubMed: 31940112
DOI: 10.1007/s11894-019-0741-2 -
The American Surgeon Jul 2023The duodenum is the second most common location for a diverticulum to form after the colon. These duodenal diverticula (DD) are often found incidentally and rarely... (Review)
Review
The duodenum is the second most common location for a diverticulum to form after the colon. These duodenal diverticula (DD) are often found incidentally and rarely require intervention. In recent years, surgical management has been restricted to patients with significant complicated sequelae, such as perforation, abscess, or fistula formation. We present the rare case of a perforated broad-based diverticulum in the third portion of the duodenum necessitating surgical correction. The patient presented with persistent symptoms following failure of conservative management and underwent surgical resection. Due to difficulty visualizing the extent of the diverticulum, a novel intraoperative technique of bowel insufflation via nasogastric tube was used allowing for elucidation of the diverticular borders and complete resection. Although DD are common, there exists no consensus on when operative intervention is indicated. Given that significant morbidity and mortality can be associated with symptomatic DD, a systematic way to guide management decisions is needed. After conducting a review of the literature, we propose that the modified Hinchey classification can be used not only to categorize duodenal diverticulitis but to guide treatment choice in cases with unclear risk benefit profiles.
Topics: Humans; Duodenal Diseases; Diverticulum; Diverticulitis; Duodenum; Intestinal Perforation
PubMed: 36533836
DOI: 10.1177/00031348221146957 -
Gaceta Medica de Mexico 2016Right aortic arch with aberrant left subclavian artery from a Kommerell's diverticulum is a very rare variant of the incomplete vascular ring. Associated symptoms are...
Right aortic arch with aberrant left subclavian artery from a Kommerell's diverticulum is a very rare variant of the incomplete vascular ring. Associated symptoms are caused due to tracheal or esophagus compression. Magnetic resonance is the gold standard for diagnosis. Surgical treatment is recommended for symptomatic patients or asymptomatic patients with a large diverticulum. We report three consecutive cases of patients with Kommerell's diverticulum, aberrant left subclavian artery, and right-sided aortic arch.
Topics: Aneurysm; Aorta, Thoracic; Cardiovascular Abnormalities; Child, Preschool; Deglutition Disorders; Diverticulum; Humans; Infant, Newborn; Magnetic Resonance Imaging; Male; Subclavian Artery
PubMed: 27335200
DOI: No ID Found -
Arab Journal of Gastroenterology : the... Aug 2022Small intestine diverticula are the most common cause of gastrointestinal hemorrhage, but prompt diagnosis remains challenging. Thus, this study aimed to identify...
BACKGROUND AND STUDY AIMS
Small intestine diverticula are the most common cause of gastrointestinal hemorrhage, but prompt diagnosis remains challenging. Thus, this study aimed to identify strategies for the diagnosis and treatment of diverticular hemorrhage.
PATIENTS AND METHODS
Patients who presented with gastrointestinal tract bleeding to Guangzhou First People's Hospital between 2008 and 2014 were retrospectively examined. Gastrorrhagia and colonic hemorrhage were excluded based on the gastroscopy and colonoscopy findings, and the bleeding sites were in the small intestine. Data regarding patient characteristics, methods of diagnosis, treatment, and prognosis were collected.
RESULTS
Eighty-five patients met the study criteria, and 45 patients were diagnosed with diverticular hemorrhage using double balloon enteroscopy, capsule endoscopy, computed tomography (CT), or digital subtraction angiography (DSA). Among these patients, 10 presented with massive bleeding and hemodynamic instability. All 45 patients underwent surgery and recovered with no complications, and all patients were followed-up for over 3 years, with no cases of recurrent hemorrhage.
CONCLUSION
Diverticular hemorrhage is the most common cause of small intestine bleeding. Double balloon enteroscopy, capsule endoscopy, CT, and DSA are effective methods for diagnosing small intestine diverticular hemorrhage. Surgical resection of the involved region is necessary and may achieve complete cure.
Topics: Diverticulum; Double-Balloon Enteroscopy; Gastrointestinal Hemorrhage; Humans; Intestinal Diseases; Intestine, Small; Retrospective Studies
PubMed: 35473683
DOI: 10.1016/j.ajg.2022.02.002 -
Aktuelle Urologie Jun 2022Since October 2018, urinary bladder diverticulum resections at our Department of Urology have been carried out with robot assistance and with minimal invasivion,...
AIMS
Since October 2018, urinary bladder diverticulum resections at our Department of Urology have been carried out with robot assistance and with minimal invasivion, Paediatrical urological and robot-assisted minimally invasive urological surgery for the Bamberg Social Foundation were performed with the DaVinci robotic system. The aim of the present study was to record the surgical results of our patients and to compare these if necessary with available data on optimal diagnostic and therapy.
METHODS
In this retrospective analysis, we included all patients who received RAHDR between October 2018 and March 2020. The primary endpoints were postoperative blood loss (postoperative haemoglobin decrease), the operation time (min), complications according to the Clavien-Dindo classification, length of hospital stay (days), postoperative residual urine, postoperative urine extravasation at the anastomosis of the bladder, postoperative quality of life and postoperative satisfaction with micturition.
RESULTS
We reviewed a total of 11 patients, all of whom were male. Mean age was 64.8 years (52-82). Average BMI was 26.5 (19-37). 3 patients were ranked with ASA score III, 5 with II and 3 with I. The average residual urine value preoperatively was 183 ml (90-240). A cystogram to rule out extravasation was performed on day 6 postoperatively. The mean duration of surgery was 212 min (148-294) and the mean duration of hospitalisation was 7.6 days (6-10). The mean residual urinary value after surgery was 25 ml (10-60). The mean postoperative maximum of flow was measured at 27.7 ml/s (11-55). No contrast agent extravasation in the cystogram was detected in any of the patients. The complications according to Clavien were not measurable. The mean postoperative haemoglobin decrease was 1.61 g/dl (0-3. 2).
CONCLUSIONS
In most cases, the removal of one or more bladder diverticula is possible using the minimally invasive robotic technique. Various surgeries such as YV-bladder neck plastic, prostate adenoma enucleation, bladder stone restoration, and inguinal herniotomy can be carried out simultaneously. A robot-assisted urinary bladder diverticulum resection is an effective and gentle procedure. However, it must be considered that it brings financial disadvantages due to the lack of adequate representation within the German DRG-system (Diagnosis Related Groups).
Topics: Diverticulum; Female; Humans; Laparoscopy; Male; Middle Aged; Quality of Life; Retrospective Studies; Robotic Surgical Procedures; Robotics; Treatment Outcome; Urinary Bladder; Urinary Retention
PubMed: 33975364
DOI: 10.1055/a-1327-5509 -
The Pan African Medical Journal 2022
Topics: Diverticulum; Humans; Magnetic Resonance Imaging; Urethral Diseases
PubMed: 35721647
DOI: 10.11604/pamj.2022.41.240.34050 -
Ophthalmic Plastic and Reconstructive... 2019To describe the demographics, presentation, treatment, and outcome in 10 cases of lacrimal sac diverticulum and to review the literature on this topic, and to determine... (Review)
Review
PURPOSE
To describe the demographics, presentation, treatment, and outcome in 10 cases of lacrimal sac diverticulum and to review the literature on this topic, and to determine the incidence of diverticula from a series of dacryocystograms.
METHODS
Data were collected for all consecutive patients with lacrimal sac diverticulum seen between 2003 and 2015, including patient demographics, clinical presentation, imaging findings, treatment, and follow-up. A systematic literature review was performed for cases of lacrimal sac diverticulum. A retrospective review of 400 consecutive dacryocystograms was performed to determine the incidence of lacrimal sac diverticulum.
RESULTS
Ten cases (9 patients) of lacrimal sac diverticulum are described, and a further 36 cases were discovered through a literature review. Epiphora, swelling, and dacryocystitis and/or diverticulitis were the most common presenting complaints. When all 46 cases are combined, lacrimal patency was demonstrated in 50% of cases. Dacryocystography diagnosed only 57% of patients with diverticulum, not helped by the addition of ultrasound or CT. The incidence of diverticulum was 3.2% on review of 400 consecutive dacryocystograms (1.6% per lacrimal system). Surgical management with dacryocystorhinostomy and/or diverticulum excision was effective in all 34 operated cases at resolving symptoms in the case series and literature review.
CONCLUSIONS
Lacrimal sac diverticula present with epiphora, medial canthal swelling, dacryocystitis, and/or diverticulitis. Dacryocystography, despite being the most sensitive radiologic test, is only 59% sensitive, and adjunctive CT and ultrasound have limited use. Surgical management is recommended because conservative management often fails. Dacryocystorhinostomy, diverticulum excision, or a combination thereof appears to be equivalent in achieving resolution of symptoms.
Topics: Adult; Dacryocystorhinostomy; Diagnosis, Differential; Diverticulum; Female; Humans; Lacrimal Apparatus Diseases; Nasolacrimal Duct; Tomography, X-Ray Computed
PubMed: 29952932
DOI: 10.1097/IOP.0000000000001156 -
Journal of Gastrointestinal Surgery :... May 2021The duodenum is traditionally reached and dissected by an anterior approach. Optimal exposure is achieved via complete hepatic flexure mobilization and kocherization of...
The duodenum is traditionally reached and dissected by an anterior approach. Optimal exposure is achieved via complete hepatic flexure mobilization and kocherization of the duodenum and head of the pancreas, which can be technically challenging and time-consuming, especially in the setting of minimally invasive surgery. On the contrary, an inframesocolic approach provides a ready and neat access to the second and third segments of the duodenum with distinct advantages in terms of exposure and operative time. This video presents the details of our laparoscopic technique of approaching the duodenum via the inframesocolic route, as performed to treat a patient with symptomatic duodenal diverticulum.
Topics: Diverticulum; Duodenum; Humans; Laparoscopy; Minimally Invasive Surgical Procedures; Pancreas
PubMed: 33555521
DOI: 10.1007/s11605-020-04905-y -
Brazilian Journal of Otorhinolaryngology 2021Sigmoid sinus diverticulum has been considered the most common cause of pulsatile tinnitus; the mechanism underlying sigmoid sinus diverticulum formation is unclear. To...
INTRODUCTION
Sigmoid sinus diverticulum has been considered the most common cause of pulsatile tinnitus; the mechanism underlying sigmoid sinus diverticulum formation is unclear. To the best of our knowledge, no previous studies have assessed whether the formation of sigmoid sinus diverticulum is related to compression of the internal jugular vein by the styloid process.
OBJECTIVE
To discuss the relationship between the styloid process and the formation of sigmoid sinus diverticulum.
METHODS
The medical records of nine patients diagnosed with venous pulsatile tinnitus caused by sigmoid sinus diverticulum were reviewed between April 2009 and May 2019. All patients underwent high-resolution computed tomography of the temporal bones, computed tomography venogram of the head and neck, magnetic resonance venography, and brain magnetic resonance imaging. The length and medial angulation of the styloid process were measured, and compression of the internal jugular vein was recorded.
RESULTS
The study population consisted of nine female right-sided pulsatile tinnitus patients with a mean age of 53.8±4.6 years. The mean lengths of the styloid process were 3.9±0.6cm on the right side and 4.1±0.7cm on the left side. The mean medial angulation of the styloid process was significantly smaller on the right side than the left side (65.3°±1.2° vs. 67.8°±1.7°, p<0.05). In addition, computed tomography venogram of the head and neck demonstrated the left internal jugular vein was compressed by the styloid process in eight of the nine patients.
CONCLUSION
The formation of sigmoid sinus diverticulum with venous pulsatile tinnitus may be related to compression of the contralateral internal jugular vein by the styloid process. However, accumulation of data in additional cases is required to verify this suggestion.
Topics: Cranial Sinuses; Diverticulum; Female; Humans; Jugular Veins; Middle Aged; Tinnitus; Tomography, X-Ray Computed
PubMed: 32044273
DOI: 10.1016/j.bjorl.2019.12.006 -
Seminars in Thoracic and Cardiovascular...Epiphrenic diverticulum is a rare and benign condition with significant surgical morbidity and evolving surgical management. The objective of this study was to analyze...
Epiphrenic diverticulum is a rare and benign condition with significant surgical morbidity and evolving surgical management. The objective of this study was to analyze short-term clinical outcomes after surgery for epiphrenic diverticula. We conducted a retrospective cohort study in a single tertiary care center of all patients who underwent treatment for epiphrenic esophageal diverticula from June 1990 to December 2016. Data collection included demographics, operative details and short-term outcomes (esophageal leak, other complications, 30-day mortality). In addition, all preoperative imaging was reviewed by an esophageal radiologist in order to describe epiphrenic diverticula characteristics in a uniform and blinded manner. Of the 94 patients in the study, 84 patients were managed with an open surgical approach and 10 with minimally invasive techniques. Median size of diverticula was 5.5 cm and mean height above gastroesophageal junction was 4 cm. A myotomy was completed in 95% of patients and a fundoplication in 58%. The MIS group had a shorter length of stay (4 vs 6 days). Overall complication rate was 27% with an esophageal leak rate of 7% with 60% grade I leaks that sealed with conservative management. Complete resection of the diverticulum, closure of the muscle over the resection, contralateral myotomy, and consideration for partial fundoplication are common strategies utilized to surgically treat patients with epiphrenic diverticulum. Minimally invasive approaches are increasingly utilized.
Topics: Diverticulum; Diverticulum, Esophageal; Fundoplication; Humans; Laparoscopy; Retrospective Studies
PubMed: 32853738
DOI: 10.1053/j.semtcvs.2020.08.017