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Mihara K, Tsunoda S, Nishigori T, Hisamori S, Okumura S, Kasahara K, Fujita Y, Sakamoto T, Morimoto T, Kinoshita H, Itatani Y, Hoshino N, Okamura R, Maekawa H, Hida K, Obama K. Midesophageal diverticulum with elevated intrabolus pressure: a case report. Surg Case Rep 2024; 10:108. [PMID: 38700566 DOI: 10.1186/s40792-024-01909-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Esophageal diverticulum is commonly associated with esophageal motility disorders, which can be diagnosed using high-resolution manometry (HRM) according to the Chicago classification. Although midesophageal diverticulum (M-ED) is associated with inflammatory processes, esophageal motility disorders have been recently identified as an etiology of M-ED. CASE PRESENTATION We present the case of a patient with M-ED and elevated intrabolus pressure (IBP), which did not meet the criteria for esophageal motility disorders according to the Chicago classification. A 71-year-old man presented with gradually worsening dysphagia for two years and was diagnosed as having an 8-cm-long M-ED and multiple small diverticula in lower esophagus. HRM revealed a median integrated relaxation pressure of 14.6 mmHg, a distal latency of 6.4 s, and an average maximum IBP of 35.7 mmHg. He underwent thoracoscopic resection of the M-ED and myotomy, which successfully alleviated the symptoms and reduced the intrabolus pressure to normal levels. CONCLUSIONS It is important to recognize the esophageal diverticulum pathology with HRM findings even in cases where the results may not meet the Chicago classification and to include myotomy based on the results.
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Affiliation(s)
- Kaito Mihara
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Shigeru Tsunoda
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Tatsuto Nishigori
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Shigeo Hisamori
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Shintaro Okumura
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Keiko Kasahara
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yusuke Fujita
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Takashi Sakamoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Tomoki Morimoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Hiromitsu Kinoshita
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yoshiro Itatani
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Nobuaki Hoshino
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Ryosuke Okamura
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Hisatsugu Maekawa
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Koya Hida
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Kazutaka Obama
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
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Shinkawa N, Yanagita M, Yukawa N, Nagatomo T. Postmortem computed tomography of barium peritonitis due to descending colon perforation. Radiol Case Rep 2024; 19:2008-2012. [PMID: 38449488 PMCID: PMC10917639 DOI: 10.1016/j.radcr.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
We describe herein the findings from postmortem computed tomography (PMCT) of barium peritonitis due to descending colon perforation. The patient was a woman in her 60s who underwent upper gastrointestinal series with barium swallow for the purpose of physical examination. The patient developed abdominal pain the next day and visited a clinic, but was sent home for later follow-up. She was found dead at home 8 days after upper gastrointestinal series. Based on the corpse phenomena and police investigations of the scene of death, the patient was estimated to have died 6 days after the upper gastrointestinal series. PMCT revealed free gas within the peritoneal cavity. Barium and fat stranding were also observed around a diverticulum in the descending colon. A large amount of residual barium was seen in the ascending colon and was considered to represent antemortem constipation and delayed barium excretion. No gas was detected in the abdominal wall, cardiac chambers or hepatic vasculature. The pancreas and adrenal glands had a normal appearance. We diagnosed barium peritonitis due to descending colon perforation as the cause of death. Diverticular perforation was suspected because barium retention and fat stranding were particularly noticeable around the descending colon diverticulum. In conclusion, we have presented a rare case of postmortem diagnosis of barium peritonitis. In PMCT interpretation, distinguishing between ante- and postmortem intestinal perforations is important.
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Affiliation(s)
- Norihiro Shinkawa
- Section of Legal Medicine, Department of Social Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
- Radiology Division, Faculty of Medicine, University of Miyazaki Hospital, Miyazaki, Japan
| | | | - Nobuhiro Yukawa
- Section of Legal Medicine, Department of Social Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Tatsuhiro Nagatomo
- Radiology Division, Faculty of Medicine, University of Miyazaki Hospital, Miyazaki, Japan
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Zhang Z, Shen J, He Q, Nie H. Spontaneous rupture of bladder diverticulum with pseudo renal failure:A case report and literature review. Am J Emerg Med 2024; 79:231.e3-231.e7. [PMID: 38508995 DOI: 10.1016/j.ajem.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Spontaneous or non-traumatic bladder rupture is rare but can be life-threatening. Bladder rupture caused by a diverticulum is extremely rare, with only a few case reports in medical literature. CASE PRESENTATION We report the case of a 32-year-old woman admitted to hospital complaints of abdominal pain, oliguria and ascites with no history of trauma. Laboratory tests revealed an elevated serum urea nitrogen(UN) level of 33.5 mmol/l and an elevated creatinine levels of 528 umol/l. X-ray cystography confirmed the rupture of a bladder diverticulum. Subsequent transurethral catheterization led to a prompt increase in urinary output, and serum creatinine level returned to 40 umol/l within 48 h. The patient was successfully treated with laparoscopic diverticulectomy. CONCLUSION Clinicians should maintain a high level of suspicion for urinary bladder rupture in cases presenting with acute lower abdominal pain, urinary difficulties, and oliguria. When acute renal failure, complicated ascites, and an elevated peritoneal fluid creatinine or potassium level exceeding serum levels are observed, intraperitoneal urine leakage should be suspected without delay. This case emphasizes the importance of early diagnosis and intervention in managing this rare but serious condition.
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Affiliation(s)
- Zhuo Zhang
- Department of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jing Shen
- Department of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qian He
- Department of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Hu Nie
- Department of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Xiamen Hospital of Sichuan University, Xiamen, Fujian, China.
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Li X, Li Y, Shi X, Cheng S, Meng T, Gao H, Shi J. Atypical Placental Site Nodules within the Diverticulum of the Uterine Incision, a Rare Gestational Trophoblastic Disease Misdiagnosed as Intrauterine Residue: A Case Report. Reprod Sci 2024; 31:555-559. [PMID: 37783889 PMCID: PMC10827965 DOI: 10.1007/s43032-023-01361-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023]
Abstract
Atypical placental site nodule (APSN) is a rare benign gestational trophoblastic disease (GTD). It is a tumor-like transformation that has a certain probability of developing into a placental site trophoblastic tumor (PSTT) or epithelioid trophoblastic tumor (ETT). Because of its atypical clinical presentation, it is difficult to diagnose and susceptible to misdiagnosis highly, thus delaying the patient's condition. We report a scarce case of atypical nodules at the placental site of the uterine incision diverticulum in a 35-year-old female, who was irregular vaginal bleeding after a cesarean Sect. 2 years. She was diagnosed by several local hospitals with intrauterine residue and was given a variety of Traditional Chinese Medicine (TCM) orally, but the symptoms of irregular vaginal bleeding have not been alleviated. After being transferred to several hospitals, she went to Hubei Maternal and Child Health Hospital for treatment. Under the condition of excluding the second pregnancy, she underwent hysteroscopic resection of lesions and laparoscopic repair of uterine incision diverticulum. The pathological diagnosis after the operation suggested that the focus at the uterine incision was an atypical placental nodule that invaded the myometrium of the uterus. The operation completely removed the focus, and then the patient was followed up every 3 months in the first postoperative year, then every 6 months up to 3 years, and then annually thereafter up to 5 years, and then maybe every 2 years thereafter. The patient's condition was quickly controlled, and the prognosis was good.
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Affiliation(s)
- Xin Li
- Medical College, Wuhan University of Science and Technology, Wuhan, 430065, People's Republic of China
| | - Yanli Li
- Department of Gynecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, People's Republic of China
| | - Xiuting Shi
- Medical College, Wuhan University of Science and Technology, Wuhan, 430065, People's Republic of China
| | - Shiyu Cheng
- Medical College, Wuhan University of Science and Technology, Wuhan, 430065, People's Republic of China
| | - Tingzhu Meng
- Medical College, Wuhan University of Science and Technology, Wuhan, 430065, People's Republic of China
| | - Han Gao
- Department of Gynecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, People's Republic of China.
| | - Jie Shi
- Department of Gynecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, People's Republic of China.
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Romeiro Victor D, de Souza Filho CA, de Albuquerque Pereira de Oliveira R, Alencar Amorim GJ, Rodrigues dos Santos Júnior C, Cardoso Cavalcanti FJ. Giant calyceal diverticulum with an extra-renal component: A case report. Urol Case Rep 2023; 49:102442. [PMID: 37288319 PMCID: PMC10242482 DOI: 10.1016/j.eucr.2023.102442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/21/2023] [Indexed: 06/09/2023] Open
Abstract
Calyceal diverticula are urine-filled non-secretory cavities that result from outpouchings of the kidney's calyx or pelvis. These cavities lie in the renal parenchyma and are linked to the kidney's collecting system through a narrow channel. They are generally small in size and present without symptoms. Here, we report the case of a middle-aged patient who was diagnosed, following imaging exams, with a giant calyceal diverticulum presenting with an extra-renal component, a remarkably rare finding. The patient's condition was successfully treated through excision by laparoscopic surgery.
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Aslan S, Önder RO. A Rare Cause of Obstructive Jaundice and Pancreatitis; Lemmel's Syndrome. Curr Med Imaging 2023; 20:CMIR-EPUB-130007. [PMID: 36876840 DOI: 10.2174/1573405619666230306104924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION/BACKGROUND Lemmel's syndrome is defined as obstructive jaundice due to a PDD in the absence of choledocholithiasis or a neoplasm. The most common cause is the presence of PDD which arise within 2-3 cm from the ampulla of Vater. Currently, there are very few case reports of this condition, which was first named in 1934 after Dr. Gerhard Lemmel. CASE PRESENTATION A 74-year-old female patient presented to the emergency department with complaints of abdominal pain and jaundice, and also had signs of pancreatitis, with laboratory results showing elevated liver and pancreatic enzymes and hyperbilirubinemia. We present a case of a patient who was diagnosed with Lemmel's syndrome after abdominal CT, MRCP, and ERCP. CONCLUSION Although rare, it is imperative for physicians to recognize this syndrome in order to deliver prompt care. Because making the correct diagnosis in these patients is very important for correct treatment and preventing the development of complications.
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Affiliation(s)
- Serdar Aslan
- Department of Radiology, Giresun University, Faculty of Medicine, Giresun, Turkey
| | - Ramazan Orkun Önder
- Department of Radiology, Giresun University, Faculty of Medicine, Giresun, Turkey
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DeWitt-Foy ME, Anele UA, Accioly JPE, Sharpe MG, Michael P, Angermeier KW. Cancer risk in bladder diverticula: a large institutional analysis of risk and management. Int Urol Nephrol 2023; 55:541-546. [PMID: 36525224 DOI: 10.1007/s11255-022-03447-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Bladder diverticula (BD) are usually asymptomatic, but may increase the risk of infections, stones, or malignancy, likely due to urinary stasis within the BD. We aim to characterize the risk of bladder cancer (BC) within diverticula. METHODS Retrospective review was conducted of patients diagnosed with BD between 1994 and 2021 at a single institution. Cancer risk was characterized using descriptive statistics and multivariable logistic regression as appropriate. RESULTS We identified 764 patients with mean age 68 years, the majority of whom were male (87%) and Caucasian (86%). Of this total, 13.3% (102/764) had a diagnosis of BC and 35.3% of this subset (36/102) had definitive cancer within the BD. Diverticulectomy or partial cystectomy was performed in 13.6% (104/764), 76% of whom were preoperatively presumed to have benign disease. Surgical patients were younger and had larger BD. Of the 79 patients who underwent diverticulectomy without preoperative suspicion for cancer, 5 were incidentally diagnosed with BC on final pathology. On multivariable logistic regression, male gender [odds ratio (OR) = 2.6, p = 0.03] and increasing age (OR = 1.02, p = 0.03) were independent risk factors for BC diagnosis. Indwelling catheter, recurrent urinary tract infections (UTIs), and bladder stones did not affect the risk of BC. CONCLUSIONS The majority of patients with BD are not managed with surgery. BC is identified in a small but considerable proportion of patients with BD, with an even lower rate of incidentally diagnosed cancer among those undergoing BD surgery. Male gender and increasing age increased the risk of BC diagnosis.
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Affiliation(s)
| | - Uzoma A Anele
- University of Louisville Health, Louisville, KY, USA
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Masabanda-Celorio VE, Alvares-Sores ED, Lara-Orosco U. [Acute cholangitis secondary to periampullary duodenal diverticulum. Case report]. Rev Med Inst Mex Seguro Soc 2023; 61:234-238. [PMID: 37201190 PMCID: PMC10395870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/31/2022] [Indexed: 05/20/2023]
Abstract
Background Periampullary duodenal diverticula are rare and pancreaticobiliary complications infrequent, however, when they are diagnosed and associated with symptoms, they warrant urgent intervention. The aim of this article is to present a clinical case of severe cholangitis secondary to the presence of a periampullary diverticulum successfully treated endoscopically. Clinical case A 68-year-old man with a history of diabetes and hypertension, was admitted to the emergency room with symptoms of abdominal pain, fever, and tachycardia. With acute kidney injury and alterations in liver function tests, ultrasound with dilated common bile duct and gallstones. Magnetic resonance cholangiography is performed, showing duodenal diverticulum and choledocholithiasis. Antibiotic management is given, and endoscopic retrograde cholangiopancreatography is decided, finding a duodenal diverticulum with stones and pus inside, sphincterotomy, transpapillary dilation and multiple sweeps are performed. Cholecystectomy was performed 7 days later, and the patient was discharged without complications. Conclusions In patients with signs of severe cholangitis, it is important not to delay endoscopic retrograde cholangiopancreatography, even when infrequent associated pathologies are evidenced, such as a periampullary duodenal diverticulum, since this represents the diagnostic and therapeutic method of choice with high rates of resolution in the case of an obstructive pathology of the bile duct.
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Affiliation(s)
- Verónica Elizabeth Masabanda-Celorio
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", Servicio de Gastrocirugía. Ciudad de México, México
| | - Erik Daniel Alvares-Sores
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", Servicio de Gastrocirugía. Ciudad de México, México
| | - Ulises Lara-Orosco
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", Servicio de Gastrocirugía. Ciudad de México, México
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Yamamoto R, Yoshida K, Ando M, Toyoda Y, Tanaka A, Kato K, Yamaguchi R. Retroperitoneal and Mediastinal Emphysema after Sigmoid Colon Resection. Case Rep Gastroenterol 2023; 17:137-142. [PMID: 36843657 PMCID: PMC9950965 DOI: 10.1159/000529282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/17/2023] [Indexed: 02/25/2023] Open
Abstract
Retroperitoneal and mediastinal emphysema after colon resection is extremely rare, especially in the absence of anastomotic leakage. The feasibility and safety of conservative treatment for this complication are unknown. We report a patient who underwent open sigmoid colon resection for colon cancer and developed retroperitoneal and mediastinal emphysema that was not caused by anastomotic leakage. Retroperitoneal and mediastinal emphysema occurred as a result of diverticular perforation. We were able to treat this patient successfully with conservative management.
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Affiliation(s)
- Ryusei Yamamoto
- Division of Surgery, Inazawa Municipal Hospital, Inazawa, Japan
| | | | - Masataka Ando
- Division of Surgery, Inazawa Municipal Hospital, Inazawa, Japan
| | | | - Aya Tanaka
- Division of Surgery, Inazawa Municipal Hospital, Inazawa, Japan
| | - Kenji Kato
- Division of Surgery, Inazawa Municipal Hospital, Inazawa, Japan
| | - Ryuzo Yamaguchi
- Division of Surgery, Inazawa Municipal Hospital, Inazawa, Japan
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Sirasapalli SK, Senthamizhselvan K, Mohan P. Rare Association of Killian-Jamieson Diverticulum and Peptic Stricture of the Esophagus: Is It Causal or Casual? Euroasian J Hepatogastroenterol 2023; 13:32-35. [PMID: 37554977 PMCID: PMC10405809 DOI: 10.5005/jp-journals-10018-1388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/23/2023] [Indexed: 08/10/2023] Open
Abstract
Killian-Jamieson diverticulum (KJD) is a rare esophageal diverticulum that arises from the anterolateral wall of the proximal cervical esophagus in the Killian-Jamieson space. Although rare presentations include dysphagia, globus sensation, or a suspected thyroid nodule, it is often asymptomatic. Treatment is indicated only in symptomatic cases. We report a 55-year-old female who had long-standing heartburn and presents now with dysphagia, weight loss, and anemia. Imaging and upper endoscopy revealed peptic stricture and an associated KJD. She underwent serial endoscopic dilatation of the peptic stricture and was symptomatically better afterwards. She is currently doing well on follow-up. How to cite this article Sirasapalli SK, Senthamizhselvan K, Mohan P. Rare Association of Killian-Jamieson Diverticulum and Peptic Stricture of the Esophagus: Is It Causal or Casual? Euroasian J Hepato-Gastroenterol 2023;13(1):32-35.
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Affiliation(s)
- Siva Krishna Sirasapalli
- Department of Medical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Kuppusamy Senthamizhselvan
- Department of Medical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Pazhanivel Mohan
- Department of Medical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
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Pascual JM, Prieto R, Carrasco R, Barrios L. Duct-like diverticulum at the base of third ventricle tumors: a morphological signature diagnostic of papillary craniopharyngioma. Neurosurg Rev 2022; 45:3361-3379. [PMID: 35982344 DOI: 10.1007/s10143-022-01848-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/02/2022] [Accepted: 08/10/2022] [Indexed: 11/27/2022]
Abstract
This study describes and characterizes a narrow, hollow tubular structure, termed as duct-like diverticulum (DV), found specifically at the basal midline of papillary craniopharyngiomas (PCPs) located within the third ventricle (3V). The presence of this structure was systematically investigated on autopsy studies and magnetic resonance imaging (MRI) scans of 3536 craniopharyngioma (CP) cases published in the medical literature from 1911 to 2021, as well as in other twelve 3V tumor categories (n = 1470 cases). A basal DV was observed in a total of 50 PCPs, including two of our own cases. This DV corresponds to a tubular-shaped recess invaginated at the midline bottom of the tumor, following the same angled trajectory as the pituitary stalk. It can be easily seen as a hypointense linear structure on T1- and T2-weighted MRI scans, with two main length types: long DVs (74%), which reach the tumor center, and short DVs (26%), which penetrate the tumor only a few millimeters. The DV sign identifies the papillary CP type with a specificity of 100% and a sensitivity of 33% in the overall CP population. This finding also serves to establish the strictly intra-3V location of the lesion with a 95% specificity and 42% sensitivity among papillary CPs. No similar basal DV was found in adamantinomatous CPs nor among other categories of strictly 3V tumors. Consequently, the presence of a diverticulum in a 3V tumor represents a morphological signature pathognomonic of the papillary type and a valuable sign to reliably define the strictly 3V topography.
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Affiliation(s)
- José María Pascual
- Department of Neurosurgery, La Princesa University Hospital, C/ Diego de León 62, 28006, Madrid, Spain.
| | - Ruth Prieto
- Department of Neurosurgery, Puerta de Hierro University Hospital, Madrid, Spain
| | - Rodrigo Carrasco
- Department of Neurosurgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - Laura Barrios
- Statistics Department, Computing Center, C.S.I.C., Madrid, Spain
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Kallel S, Chaabouni MA, Thabet W, Mnejja M, Ben Mahfoudh K, Charfeddine I. Tracheocele: A Rare Entity. Iran J Otorhinolaryngol 2022; 34:191-194. [PMID: 36035650 PMCID: PMC9392997 DOI: 10.22038/ijorl.2022.53313.2815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/10/2022] [Indexed: 11/06/2022]
Abstract
Introduction Tracheocele or tracheal diverticulum is an uncommon benign entity that can be congenital or acquired. It is usually diagnosed incidentally on cervicothoracic imaging. Our aim is to describe the etiopathogenic, clinical and paraclinical features of the tracheocele as well as its therapeutic modalities. Case Report We report 2 cases of asymptomatic congenital tracheocele occurred in a boy and a woman, incidentally found on cervical CT scan done for accidental ingestion of chicken bone and infected thyroid hematocele respectively. The tracheocele, in our 2 cases, was probably congenital: no risk factors were noted and the opening of the tracheocele was narrow. The tracheocele was located in the right posterolateral tracheal wall in the 2 cases. It communicated with the tracheal lumen in one case. The female patient underwent a right lobectomy and resection of the tracheocele. For the boy, our attitude was conservative. The evolution was uneventful in the 2 cases. Conclusions The presence or absence of risk factors, CT scan, bronchoscopy and histologic exam may distinguish between congenital and acquired forms. Asymptomatic patients are managed conservatively. Surgical resection is the treatment of choice for symptomatic patients.
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Affiliation(s)
- Souha Kallel
- Department of ENT and Cervicofacial Surgery. Habib Bourguiba’s Teaching Hospital, El Ferdaous Avenue, 3029 Sfax, Tunisia. University of Sfax. ,Corresponding Author: Department of ENT and Cervicofacial Surgery. Habib Bourguiba’s Teaching Hospital, El Ferdaous Avenue, 3029 Sfax, Tunisia. E-mail adress:
| | - Mohamed Amin Chaabouni
- Department of ENT and Cervicofacial Surgery. Habib Bourguiba’s Teaching Hospital, El Ferdaous Avenue, 3029 Sfax, Tunisia. University of Sfax.
| | - Wadii Thabet
- Department of ENT and Cervicofacial Surgery. Habib Bourguiba’s Teaching Hospital, El Ferdaous Avenue, 3029 Sfax, Tunisia. University of Sfax.
| | - Malek Mnejja
- Department of ENT and Cervicofacial Surgery. Habib Bourguiba’s Teaching Hospital, El Ferdaous Avenue, 3029 Sfax, Tunisia. University of Sfax.
| | - Khaireddine Ben Mahfoudh
- Department of Radiology. Habib Bourguiba’s Teaching Hospital, El Ferdaous Avenue, 3029 Sfax, Tunisia.
| | - Ilhem Charfeddine
- Department of ENT and Cervicofacial Surgery. Habib Bourguiba’s Teaching Hospital, El Ferdaous Avenue, 3029 Sfax, Tunisia. University of Sfax.
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13
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Kimura T, Goi T, Kidoguchi Y, Ohnishi K, Togawa T, Iida A, Sato Y. A case of diverticulum of the appendiceal base resembling a submucosal tumor of the cecum under colonoscopy: a hitherto undescribed lesion. BMC Gastroenterol 2022; 22:262. [PMID: 35619064 PMCID: PMC9137188 DOI: 10.1186/s12876-022-02337-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 05/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diverticulosis of the appendix is an uncommon clinical entity, and a preoperative diagnosis is often difficult. Herein we report an unusual case of appendiceal diverticulosis. CASE PRESENTATION A 72-year-old male was referred to our hospital to examine the cause of hematochezia. A colonoscopy study showed a protruding lesion resembling a submucosal tumor (SMT), approximately 20 mm in diameter, at the site around the appendiceal orifice of the cecum. An abdominal computed tomography and magnetic resonance imaging showed a cystic lesion at the appendiceal base. The lesion was clinically diagnosed as a cystic tumor of the appendix, but the possibility of a malignant tumor could not be excluded. Therefore, a laparoscopic ileocecal resection with lymph node dissection was performed. The pathological examination of the resected specimen revealed that the lesion was a diverticulum (pseudodiverticulum) occurring solitarily at the appendiceal base, in which the mucosal layer of the appendix was invaginated into the submucosa of the adjacent cecum, thus forming an SMT-like lesion. CONCLUSION To our knowledge, this is the first case report in the English literature showing that an appendiceal diverticulum can manifest as an SMT-like lesion in the cecum. This condition should be recognized as a differential diagnosis for such lesions.
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Affiliation(s)
- Toshihisa Kimura
- Department of Surgery, National Hospital Organization, Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui 914-0195 Japan
- First Department of Surgery, Faculty of Medicine, University of Fukui, 23-3, Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193 Japan
| | - Takanori Goi
- First Department of Surgery, Faculty of Medicine, University of Fukui, 23-3, Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193 Japan
| | - Yuki Kidoguchi
- Department of Surgery, National Hospital Organization, Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui 914-0195 Japan
| | - Kenji Ohnishi
- Department of Surgery, National Hospital Organization, Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui 914-0195 Japan
| | - Tamotsu Togawa
- Department of Surgery, National Hospital Organization, Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui 914-0195 Japan
| | - Atsushi Iida
- Department of Surgery, National Hospital Organization, Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui 914-0195 Japan
| | - Yasunori Sato
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8640 Japan
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14
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Hematian MN, Torabi S, Hantoushzadeh S, Dehestani A, Dadkhah M, Shabanian R. Prenatal diagnosis of accessory mitral valve tissue in a fetus with persistent dysrhythmia. Egypt Heart J 2022; 74:26. [PMID: 35403983 DOI: 10.1186/s43044-022-00263-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 04/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Accessory mitral valve tissue (AMVT) is a rare congenital cardiac anomaly that mainly diagnosed in the first decade of life. However, asymptomatic cases may not be diagnosed even up to adulthood. We report a fetus with AMVT to show the diagnostic ability of the fetal echocardiography for detection of this pathology in the prenatal period. Case presentation AMVT was diagnosed in a 26-week-old male fetus with persistent dysrhythmia. Dysrhythmia could not be aborted and controlled by sotalol till the third trimester evaluation. Apical left ventricular (LV) diverticulum was the additional finding in his fetal echocardiogram. After birth, he was in sinus rhythm and echocardiography confirmed the presence of AMVT, however, without any evidence of LV apical diverticulum.
Conclusions The diagnosis of AMVT in the prenatal period is possible by fetal echocardiography. Supplementary Information The online version contains supplementary material available at 10.1186/s43044-022-00263-z.
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15
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Takasu A, Ikeya T, Shiratori Y. Comparison of Conventional and New Endoscopic Band Ligation Devices for Colonic Diverticular Bleeding. Clin Endosc 2022; 55:408-416. [PMID: 35184514 PMCID: PMC9178147 DOI: 10.5946/ce.2021.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/04/2021] [Indexed: 11/14/2022] Open
Abstract
Background/Aims Endoscopic band ligation (EBL) is used to treat colonic diverticular bleeding (CDB). An endoscopic variceal ligation device for esophageal varices is used as a conventional EBL device (C-EBL). A new EBL device (N-EBL) was developed by Sumitomo Bakelite in August 2018. We aimed to evaluate the clinical outcomes of N-EBL compared with those of C-EBL. Methods Seventy-nine patients who underwent EBL for CDB at St. Luke's International Hospital, Japan, between 2017 and 2020 were included in this retrospective study. Patients were divided into the C-EBL and N-EBL groups. Their clinical outcomes, including achieving initial hemostasis, early rebleeding, procedure time, and EBL-associated adverse events, were evaluated. Results Of the 79 patients, 36 (45.6%) were in the C-EBL group and 43 (54.4%) were in the N-EBL group. The rate of achieving initial hemostasis was 100% in the C-EBL group and 93.0% in the N-EBL group. No significant difference was noted in the early rebleeding rate between the groups (P=0.24). The N-EBL group achieved a shorter median EBL procedure time than the C-EBL group (18.2 min vs. 14.2 min, P=0.02). No adverse events were observed in either group. Conclusions The N-EBL device is safe and useful and may reduce EBL procedure time.
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Affiliation(s)
- Ayaka Takasu
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Takashi Ikeya
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Yasutoshi Shiratori
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
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16
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Wang WL, Wei PL, Chang IW. A Rare Presentation of Lower Abdominal Pain. Gastroenterology 2021; 161:e15-e17. [PMID: 33915171 DOI: 10.1053/j.gastro.2021.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Wei-Lin Wang
- Division of Colorectal Surgery, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Po-Li Wei
- Division of Colorectal Surgery, Taipei Medical University Hospital, Taipei, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - I-Wei Chang
- Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Clinical Pathology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Pathology, Taipei Medical University Hospital, Taipei, Taiwan.
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17
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Senti M, Torres TA, Espinosa J, Shebrain S. Unusual Presentation of a Gastrointestinal Stromal Tumor in a Small Intestine Diverticulum. Case Rep Gastroenterol 2021; 15:667-673. [PMID: 34720825 PMCID: PMC8458927 DOI: 10.1159/000518019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/11/2021] [Indexed: 11/25/2022] Open
Abstract
A 50-year-old female with no significant medical history initially presented to an urgent care center with symptoms of acute onset abdominal pain, nausea, and emesis. Chest and abdominal X-ray revealed free air under the diaphragm, prompting immediate transfer to the emergency department. Continued abdominal tenderness and pain were concerning for perforated viscus. The patient was transferred to the operating room, and diagnostic laparoscopy was performed. Inflammation and contamination were discovered in the right side of the abdomen and pelvis secondary to a small bowel (SB) perforation. Segmental SB resection revealed a perforated diverticulum. Pathological examination confirmed a diagnosis of gastrointestinal stromal tumor (GIST) at the perforated segment. On postoperative day 5, the patient was discharged home, and at 30-month follow-up, the patient continued to do well. Although rare, SB diverticula are commonly false (i.e., pseudodiverticula). The concomitant presence of a GIST in a true SB diverticulum presenting with perforation has not yet been reported.
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Affiliation(s)
- Mackenna Senti
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
| | - Tania A Torres
- Department of Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
| | - Jairo Espinosa
- Department of Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
| | - Saad Shebrain
- Department of Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
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18
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Kim HW, Lee JZ, Shin DG. Pathophysiology and Management of Long-term Complications After Transvaginal Urethral Diverticulectomy. Int Neurourol J 2021; 25:202-9. [PMID: 34610713 DOI: 10.5213/inj.2142006.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/22/2021] [Indexed: 11/08/2022] Open
Abstract
Female urethral diverticulum (UD) is a rare and benign condition that presents as an epithelium-lined outpouching of the urethra. It has various symptoms, of which incontinence in the form of postmicturition dribble is the most common. The gold standard for the diagnosis of UD is magnetic resonance imaging, and the treatment of choice is transvaginal diverticulectomy. Despite the high success rate of transvaginal diverticulectomy, postoperative complications such as de novo stress urinary incontinence (SUI), recurrence, urethrovaginal fistula, recurrent urinary tract infections, newly-onset urgency, and urethral stricture can occur. De novo SUI is thought to result from weakening of the anatomical support of the urethra and bladder neck or damage to the urethral sphincter mechanism during diverticulectomy. It can be managed conservatively or may require surgical treatment such as a pubovaginal sling, Burch colposuspension, or urethral bulking agent injection. Concomitant SUI can be managed by concurrent or staged anti-incontinence surgery. Recurrent UD may be a newly formed diverticulum or the result of a remnant diverticulum from the previous diverticulectomy. In cases of recurrent UD requiring surgical repair, placing a rectus fascia pubovaginal sling may be an effective method to improve the surgical outcome. Urethrovaginal fistula is a rare, but devastating complication after urethral diverticulectomy; applying a Martius flap during fistula repair may improve the likelihood of a successful result. Malignancies in UD are rarely reported, and anterior pelvic exenteration is the recommended management in such cases.
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19
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Rocha-Arrieta MC, Arias-Díaz A, Soto Zárate EF, Vergara Vergara GE, Aristizábal Villa GJ, Brochet Bayona GA. [Ventricular diverticulum in Cantrell´s pentalogy: rare but not isolated entities]. Arch Peru Cardiol Cir Cardiovasc 2021; 2:263-267. [PMID: 37727665 PMCID: PMC10506561 DOI: 10.47487/apcyccv.v2i4.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/05/2021] [Indexed: 09/21/2023]
Abstract
Pentalogy of Cantrell is a rare entity characterized by a combination of alterations, among which the following stand out: defects of the pericardium, heart, diaphragm, lower third of sternum and abdominal wall. On the other hand, congenital cardiac diverticulum is a rare malformation whose presentation is associated with Cantrell's pentalogy in some cases. We present the case of a child with Cantrell's pentalogy who, during follow-up, was diagnosed with left ventricular diverticulum, which required surgical management with a favorable outcome. Addressing these conditions requires the use of cardiovascular images that allow timely decision-making by the treating team.
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Affiliation(s)
| | - Antonio Arias-Díaz
- Unidad de Cuidados Intensivos Pediátricos Doña Pilar. Cartagena, Colombia. Unidad de Cuidados Intensivos Pediátricos Doña Pilar Cartagena Colombia
| | - Enrique Felipe Soto Zárate
- Universidad de Cartagena. Cartagena, Colombia. Universidad de Cartagena Universidad de Cartagena Cartagena Colombia
| | - Gabriel Elias Vergara Vergara
- Centro Diagnóstico de Imágenes y Radiología. Cartagena, Colombia. Centro Diagnóstico de Imágenes y Radiología Cartagena Colombia
| | | | - Gustavo Adolfo Brochet Bayona
- Hospital Infantil Napoleón Franco Pareja. Cartagena, Colombia Hospital Infantil Napoleón Franco Pareja Cartagena Colombia
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20
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Abushamma F, Ito H, Aboumarzouk O, Timoney A, Collin N, Keeley FX. Calyceal Diverticula Disease: Diagnosis and Management Options in the Era of Non-Contrast CT Scan. Urol Int 2021; 106:688-692. [PMID: 34515232 DOI: 10.1159/000518051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 06/22/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Calyceal diverticula (CD) are traditionally diagnosed by contrast studies. However, non-contrast CT is the standard imaging modality for kidney stones. Therefore, we aimed to determine if the lack of contrast imaging affected outcomes of the management of symptomatic CD with stone. MATERIALS AND METHODS This is a retrospective study of patients diagnosed with CD with intracalyceal stone from 2000 to 2017 analyzing demographics, clinical data, and success of different treatment options. The timing of CD diagnosis is correlated to the success of the first treatment. RESULTS Forty-eight patients were found. CD was diagnosed prior to intervention in 20 (42%) cases and intraoperatively during flexible ureteroscopy in 17 (35%) and 11 (23%) cases were diagnosed after failed intervention, mainly ESWL. We found that the success rate of treatment was highly affected by the timing and modality of diagnosis. Preoperative diagnosis of CD was associated with 69% success rate of the first intervention. In contrast, there was a 0% success rate of first treatment if CD was not diagnosed with contrast imaging. Furthermore, univariate analysis showed no significant association between sociodemographics and clinical variables and success treatment (p > 0.05). CONCLUSIONS The delay in diagnosing CD with stone contributes significantly to the success rate and the number of treatments.
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Affiliation(s)
- Faris Abushamma
- Department of Medicine, Faculty of medicine and health Sciences, An-Najah National University, Nablus, Palestine.,Department of Urology, An-Najah National University Hospital, Nablus, Palestine.,Bristol Urological Institute, North Bristol NHS Trust, Bristol, United Kingdom
| | - Hiroki Ito
- Department of Urology, Yokosuka Kyosai Hospital, Kanagawa, Japan
| | - Omar Aboumarzouk
- Surgical Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Anthony Timoney
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, United Kingdom
| | - Neil Collin
- Interventional Radiology Department, Southmead Hospital, Bristol, United Kingdom
| | - Francis X Keeley
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, United Kingdom
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21
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Abstract
Background Zenker’s diverticulum (ZD) is an uncommon disorder due to an outpouching of tissue through the Killian triangle that is thought to be caused by dysfunction of the cricopharyngeal muscle. Case presentation An 85-year-old male patient presented with odynophagia and dysphagia of initially solid food followed by fluids that was associated with a significant weight loss over a one-year period. Barium swallow videofluoroscopy demonstrated a posterior outpouching of proximal esophagus that was 2 cm from the epiglottis. With the diagnosis of medium sized ZD, the patient underwent endoscopy guided diverticulotomy. Six months after the procedure, he was asymptomatic and had gained weight. Conclusions Dysphagia and weight loss raises a clinical suspicion for a malignancy. Barium swallow examination is an inexpensive method for the diagnosis of ZD.
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Affiliation(s)
- Senai Goitom Sereke
- Department of Radiology and Radiotherapy, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Felix Bongomin
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Zeridah Muyinda
- Department of Radiology, Mulago National Referral Hospital, Kampala, Uganda
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22
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Sow O, Sarr A, Ze Ondo C, Sine B, Ndiath A, Ndoye AK. Giant bladder diverticulum in a postmenopausal woman: Case report and literature review. Urol Case Rep 2021; 39:101807. [PMID: 34430215 DOI: 10.1016/j.eucr.2021.101807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/21/2022] Open
Abstract
Bladder diverticulum represents a herniation of the bladder mucosa and submucosa through a point of weakness in the detrusor muscle. Bladder diverticula are rare and most often described in men. We report a symptomatic giant bladder diverticulum in a 56-year-old postmenopausal woman. The symptomatology was marked by acute urinary retention associated with abdominal-pelvic pain. A diverticulectomy by a transvesical approach with placement of a urethral catheter was performed. The postoperative course was uneventful.
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23
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Ishimaru N, Fujikawa H, Kondo S, Kobayashi Y. Ectopic ovary presenting as mesenteric abscess. Ann R Coll Surg Engl 2021; 103:e285-e287. [PMID: 34414779 DOI: 10.1308/rcsann.2021.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Ectopic ovary is a rare gynaecological condition that results in problems with menstruation and pregnancy and may develop into a malignant tumour. However, as the condition is often asymptomatic, diagnosis is difficult and frequently delayed. We report a case of a 42-year-old female who presented with a 10-day history of abdominal pain. The patient underwent surgery that confirmed the diagnosis of an ectopic ovary with an internal abscess. The findings of our study indicate that ectopic ovaries can present with an abscess. Ectopic ovaries should be included in the differential diagnosis of masses with internal abscesses.
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Affiliation(s)
| | - H Fujikawa
- Suwa Central Hospital, Nagano, Japan.,The University of Tokyo, Tokyo, Japan
| | - S Kondo
- Suwa Central Hospital, Nagano, Japan
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24
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Lu Y, Qi C, Xu H, Jin M. Differential diagnosis of appendiceal serrated lesions and polyps and low-grade appendiceal mucinous neoplasm: analysis of 88 cases. J Cancer Res Clin Oncol 2021; 148:1761-1769. [PMID: 34368907 DOI: 10.1007/s00432-021-03757-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To identify clinicopathological features for the differential diagnosis of appendiceal serrated lesions and polyps (SPs) and low-grade appendiceal mucinous neoplasm (LAMN) for the purpose of avoiding over-diagnosis. METHODS Clinical data and pathological features of 66 patients with SPs diagnosed at the Aerospace Center Hospital between January 2013 and January 2021 were collected and compared to 22 cases of LAMN. RESULTS SPs, compared with LAMN, are likely to be associated with acute inflammation (SPs 53.0% vs. LAMN 18.2%), and may be located in the appendix partly, although with smaller diameter (average 9.6 vs. 27.2 mm); epithelial structures of serrated (100% vs. 22.7%) and filiform villous (47.0% vs. 18.2%) were often found in SPs. SPs occasionally show attenuated or flattened morphology (16.7% vs. 100%) and undulating or scalloped (7.6% vs. 40.9%) structures, and can also be accompanied by diverticulum (18.2% vs. 18.2%) and acellular mucin in the appendiceal wall (16.7% vs. 54.5%), which causes confusion with LAMN. The key point of the differential diagnosis is to observe whether the muscularis mucosa exists (loss, 0% vs. 100%) and fibrosis of the appendiceal wall (0% vs. 100%). SMA immunohistochemistry can assist in the diagnosis. Calcification is also indicative of LAMN. CONCLUSIONS The epithelial structure of SPs can appear flattened and focally scalloped, and can be accompanied by mucin in the appendiceal wall, which may appear as complex lesions, easily over-diagnosed as LAMN. Key differential diagnostic features are identifying the structure of lamina propria, determining whether the muscularis mucosa exists, and whether the appendiceal wall is fibrotic.
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Affiliation(s)
- Yiyan Lu
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, No.8 Gongren Tiyuchang South Road, Chaoyang District, Beijing, 100020, China.,Department of Pathology, Aerospace Center Hospital, Beijing, China
| | - Changhai Qi
- Department of Pathology, Aerospace Center Hospital, Beijing, China
| | - Hongbin Xu
- Department of Myxoma, Aerospace Center Hospital, Beijing, China
| | - Mulan Jin
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, No.8 Gongren Tiyuchang South Road, Chaoyang District, Beijing, 100020, China.
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25
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Turner GA, O'Grady MJ, Purcell RV, Frizelle FA. The Epidemiology and Etiology of Right-Sided Colonic Diverticulosis: A Review. Ann Coloproctol 2021; 37:196-203. [PMID: 34284562 PMCID: PMC8391037 DOI: 10.3393/ac.2021.00192.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/01/2021] [Indexed: 11/03/2022] Open
Abstract
Diverticulosis of the colon is a common condition in Western countries and most patients will remain asymptomatic, but some will present with symptoms of acute diverticulitis or bleeding. Our understanding of diverticulosis is evolving but is mostly derived from diverticulosis affecting the left-sided colon. In contrast, right-sided colonic diverticulosis (RCD) is more commonly seen in Asian countries but is much less common overall. Based on the marked differences in epidemiology, it is commonly thought that these are 2 distinct disease processes. A review of the literature describing the epidemiology and etiology of RCD was performed, with a comparison to the current understanding of left-sided diverticulosis. RCD is becoming increasingly common. The epidemiology of RCD shows it to be a mostly acquired condition, and not congenital as previously thought. Many factors in the etiology of RCD are similar to that seen in left-sided diverticulosis, with a few variations. It is therefore likely that most cases of RCD represent the same disease process that is seen in the left colon.
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Affiliation(s)
- Greg A Turner
- Department of Surgery, University of Otago, Christchurch, New Zealand.,Colorectal Unit, Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Michael J O'Grady
- Department of Surgery, University of Otago, Christchurch, New Zealand.,Colorectal Unit, Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Rachel V Purcell
- Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Frank A Frizelle
- Department of Surgery, University of Otago, Christchurch, New Zealand.,Colorectal Unit, Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand
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26
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Nabi Z, Chavan R, Asif S, Ramchandani M, Basha J, Darisetty S, Goud R, Kotla R, Reddy DN. Per-oral Endoscopic Myotomy with Division of Septum (D-POEM) in Epiphrenic Esophageal Diverticula: Outcomes at a Median Follow-Up of Two Years. Dysphagia 2021. [PMID: 34212259 DOI: 10.1007/s00455-021-10339-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/24/2021] [Indexed: 10/21/2022]
Abstract
Esophageal epiphrenic diverticula (EED) are rare pulsion-type outpouchings at the lower end of esophagus. Traditionally, surgery has been performed in EED. More recently, per-oral endoscopic myotomy with septotomy (D-POEM) has emerged as an option in these cases. In this study, we aim to determine the efficacy and safety of D-POEM in cases with EED. The data of cases who underwent D-POEM in cases with EED from March 2013 to Nov 2020 were analyzed, retrospectively. The primary outcome of the study was clinical success. Secondary outcomes included technical success, procedure duration, reflux esophagitis, and adverse events. 13 patients (males 9, 48.07 ± 17.55 years) with EED underwent D-POEM during the study period. Median size of the EED was 45 mm (range 25-70). Associated esophageal motility disorder was found in 10 (76.9%) cases including type II achalasia (3), type I (3), hypercontractile esophagus (2), and unspecified (2). Technical success was achieved in 12 (92.3%) cases. Median length of total and gastric myotomies were 10 cm (range 6-20) and 3 cm (1-3), respectively. At a median follow-up of 25 months, clinical success was achieved in 84.6% cases. Mean integrated relaxation pressures reduced significantly after POEM procedure (25.80 ± 13.24 vs 9.40 ± 3.10, p = 0.001). There was one major adverse event requiring surgical intervention. D-POEM is an effective procedure in cases with EED. Long-term follow-up studies are required to ascertain the durability of response in these cases.
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Mandavdhare HS, Praveen Kumar M, Jha D, Kumar A, Sharma V, Desai P, Shumkina L, Gupta P, Singh H, Dutta U. Diverticular per oral endoscopic myotomy (DPOEM) for esophageal diverticular disease: a systematic review and meta-analysis. Esophagus 2021; 18:436-50. [PMID: 33880689 DOI: 10.1007/s10388-021-00839-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/02/2021] [Indexed: 02/03/2023]
Abstract
The traditional way to tackle Zenker's diverticulum (ZD) has been flexible endoscopic septum division (FESD). Recently, the concept of per oral endoscopic myotomy has been found useful for managing diverticular diseases of the esophagus and has been termed DPOEM. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of D-POEM in diverticular disease of the esophagus and to compare it with FESD. We systematically searched PubMed and Embase, for studies reporting clinical success, technical success and adverse events in D-POEM alone or D-POEM comparing with FESD. We computed pooled prevalence for D-POEM alone and risk ratio for D-POEM vs FESD using random effect method with inverse variance approach. Subgroup analysis for ZD, non-ZD and mixed diverticulum was conducted. Totally 19 studies including 341 patients were identified reporting on D-POEM. The pooled clinical, technical success and adverse event rates for D-POEM were 87.07%, 95.19% and 10.22%, respectively. The clinical success was significantly better than FESD while the technical success, adverse event rate, procedure time and length of hospital stay were comparable with FESD. The recurrence rate was negligible for D-POEM compared to FESD. On subgroup analysis by dividing into three groups of ZD, non-ZD and mixed, there was no difference between clinical, technical success and adverse event rate among the three groups. D-POEM is an effective and safe technique among both ZD and non-ZD patients and has better clinical success than FESD.
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Toro-Ortiz JP, Fernández-García F, Pinazo-Bandera J, Alcaín Martínez GJ, Lavín Castejón I. Endoscopic septotomy of Zenker's diverticulum with Stag-Beetle Knife™: A descriptive observational study and literature review. Gastroenterol Hepatol 2021:S0210-5705(21)00199-0. [PMID: 34129902 DOI: 10.1016/j.gastrohep.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/20/2021] [Accepted: 06/04/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Zenker's diverticulum (ZD) is a protrusion of the hypopharyngeal mucosa with a prevalence of 2/100,000 inhabitants. The symptoms of the patients determine the need for treatment, which can be surgical or endoscopic. The latter, known as endoscopic septotomy or diverticulotomy (ED), this involves dissecting the diverticular septum, which can be performed with different dissection devices. AIM The aim of our study was to evaluate the efficacy and safety of ED with Stag-Beetle-Knife™ device, as well as to conduct a literature review to assess the position of the technique in the current scientific panorama. MATERIAL AND METHODS Descriptive retrospective study that includes patients who underwent ED with SB-Knife™ between June 2017 and February 2020. Literature review of the available evidence between January 2013 and April 2020 of ED with SB-Knife™ technique and its variants. RESULTS Twelve patients (66% male) with a median age of 70.5 years were collected. The median size of diverticular was 32.5mm and complete remission was observed in 75% of the cases. Fourteen interventions were performed with a technical success of 92.8. There were no serious complications. A literature review was carried out, finding 13 papers, of which 8 were finally included (6 retrospective studies, a series of cases and a clinical case). CONCLUSION Based on our experience and the reviewed literature, we consider ED with SB-Knife™ is a safe, effective and reproducible technique, and may be a better alternative to surgery in patients with ZD.
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Khoury T, Sbeit W. Peri-ampullary diverticulum was associated with a higher rate of acute cholangitis among patients with choledocholithiasis. Surg Endosc 2021. [PMID: 34101011 DOI: 10.1007/s00464-021-08586-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Choledocholithiasis is a commonly encountered disease that is associated with various clinical presentations ranging from mild form of biliary colic to severe life-threatening acute cholangitis. Recently, peri-ampullary diverticulum (PAD) has been linked to the development of biliary diseases; however, data regarding its association with the development of acute cholangitis in the setting of choledocholithiasis are scarce. AIMS We aimed to identify predictors, specifically PAD, for the development of acute cholangitis in patients with choledocholithiasis. METHODS We performed a retrospective cross-sectional study of all patients admitted to Galilee Medical Center from 1 January 2010 to 31 December 2019 with different clinical presentations of documented choledocholithiasis including cholangitis, biliary pancreatitis, and biliary colic with abnormal liver enzymes. RESULTS Overall, 651 patients were included in the final analysis. Among them, 88 patients (13.5%) had choledocholithiasis associated with acute cholangitis (group A), as compared to 563 patients (86.5%) without acute cholangitis (group B). The average ages in groups A and B were 77.8 ± 13.6 and 62.4 ± 20.4 years, respectively (P < 0.0001). The rate of PAD was significantly higher in group A as compared to group B (35.2% vs. 19%, P = 0.0002). However, the rate of smoking, chronic liver diseases, hemolytic anemia, and post-cholecystectomy status were not different between the groups (P = 0.3, P = 0.3, P = 0.2, and P = 0.3), respectively. On univariate analysis, age (OR 1.05, P < 0.0001) and PAD (OR 2.32, P = 0.0006) were significantly associated with acute cholangitis. On multivariate logistic regression analysis, the effects of age and PAD were preserved (OR 1.05, 95% CI 1.03-1.07, P < 0.0001 and OR 1.64, 95% CI 1.02-2.72, P = 0.049), respectively. CONCLUSION PAD showed a significant association with the development of acute cholangitis among patients with choledocholithiasis. Identification of gallbladder and biliary stones in patients with PAD is of paramount importance since early diagnosis and treatment might prevent further life-threatening complications.
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Rizzo GEM, Ferro G, Rizzo G, Carlo GD, Cantone A, Vita GGD, Sciumè C. Endoscopic Treatment of Iatrogenic Perforation of Sigmoid Diverticulum: A Case Report of Multidisciplinary Management. Clin Endosc 2021; 55:292-296. [PMID: 34092055 PMCID: PMC8995985 DOI: 10.5946/ce.2021.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/08/2021] [Indexed: 11/14/2022] Open
Abstract
Iatrogenic perforations are severe complications of gastrointestinal endoscopy; therefore, their management should be adequately planned. A 77-year-old man with a history of diverticulosis underwent a colonoscopy for anemia. During the procedure, an iatrogenic perforation occurred suddenly in the sigmoid colon, near a severe angle among the numerous diverticula. Through-the- scope clips were immediately applied to treat it and close mucosal edges. Laboratory tests showed increased inflammation and infection, and although there were no complaints of abdominal pain, the patient had an extremely distended abdomen. A multidisciplinary board began management based on a conservative approach. Pneumoperitoneum was treated with computed tomography-assisted drainage. After 72 hours, his intestinal canalization and laboratory tests were normal. Though this adverse event is rare, a multidisciplinary board should be promptly gathered upon occurrence, even if the patient appears clinically stable, to consider a conservative approach and avoid surgical treatment.
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Affiliation(s)
- Giacomo Emanuele Maria Rizzo
- Section of Gastroenterology & Hepatology, Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy.,Section of Endoscopy, Department of General Surgery, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Giuseppina Ferro
- Section of Endoscopy, Department of General Surgery, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Giovanna Rizzo
- Department of Surgical, Oncological and Oral Science, Palermo University Hospital, Palermo, Italy.,Section of Endoscopy, Department of General Surgery, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Giovanni Di Carlo
- Section of Endoscopy, Department of General Surgery, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Alessandro Cantone
- Section of Endoscopy, Department of General Surgery, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Gaetano Giuseppe Di Vita
- Department of Surgical, Oncological and Oral Science, Palermo University Hospital, Palermo, Italy
| | - Carmelo Sciumè
- Department of Surgical, Oncological and Oral Science, Palermo University Hospital, Palermo, Italy.,Section of Endoscopy, Department of General Surgery, San Giovanni di Dio Hospital, Agrigento, Italy
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Roh S. Foregut Diverticula. Korean J Fam Med 2021; 42:191-196. [PMID: 31658807 PMCID: PMC8164925 DOI: 10.4082/kjfm.18.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/26/2018] [Accepted: 11/13/2018] [Indexed: 11/23/2022] Open
Abstract
Diverticular disease can present anywhere along the gastrointestinal (GI) tract. It can result from various pathologies such as abnormal contraction within the GI tract or inflammation causing scar tissue and the resulting forces surrounding the GI tract. Its clinical presentation can vary from asymptomatic to severe symptoms, with significant decrease in quality of life. The treatment for various diverticula along the GI tract can also vary, depending on the severity of symptoms. This article describes diverticular disease occurring within the foregut, with emphasis on pathophysiology, clinical presentation, and treatment.
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Affiliation(s)
- Simon Roh
- Division of Interventional Radiology, New York Presbyterian Hospital–Weill Cornell Medical Center, New York, NY, USA
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Cnaan RB, Abumanhal M, Wengier A, Feldman I, Leibovitch I, Abergel A. Lacrimal sac diverticulum: clinical presentation and endoscopic management. Eur Arch Otorhinolaryngol 2021; 279:199-203. [PMID: 33772319 DOI: 10.1007/s00405-021-06773-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND To describe the clinical presentation, surgical intervention and clinical outcomes of patients with a lacrimal sac diverticulum. METHODS Retrospective chart review of all patients who underwent endonasal endoscopic dacryocystorhinostomy (DCR) in a single medical center from January 2010 to October 2020. The diagnosis of a lacrimal sac diverticulum was based upon intraoperative findings. RESULTS In total, 406 patients underwent endonasal endoscopic DCR during the study period. Eight female patients (mean age 35 years) were diagnosed with a lacrimal diverticulum and underwent DCR by an endonasal endoscopic approach. The mean follow-up period was 11.5 months. All eight patients had cystic findings at the lacrimal fossa on imaging studies prior to surgery. Five patients had a history of dacryocystitis. The main presenting symptoms were epiphora and/or medial canthal swelling. The diverticulum was identified on the inferior wall in seven cases. A dacryolith in the lacrimal sac was identified intraoperatively in two patients. All patients showed full resolution of symptoms after surgery. There were no intraoperative or postoperative complications. CONCLUSION Lacrimal sac diverticulum is a rare entity with female predominance. It may be the underlying etiology of epiphora and/or dacryocystitis. The diagnosis is based upon identifying the presence of a diverticulum intraoperatively. Endoscopic DCR is an effective approach for integrating both the lacrimal sac and diverticulum cavities into a single space, leading to resolution of symptoms.
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Affiliation(s)
- Ran Ben Cnaan
- Oculoplastics Institute, Division of Ophthalmology, Tel Aviv Sourasky Medical Center Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Muhammad Abumanhal
- Oculoplastics Institute, Division of Ophthalmology, Tel Aviv Sourasky Medical Center Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Wengier
- Oculoplastics Institute, Division of Ophthalmology, Tel Aviv Sourasky Medical Center Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Ear, Nose and Throat Department, Tel Aviv Sourasky Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Feldman
- Oculoplastics Institute, Division of Ophthalmology, Tel Aviv Sourasky Medical Center Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Igal Leibovitch
- Oculoplastics Institute, Division of Ophthalmology, Tel Aviv Sourasky Medical Center Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avraham Abergel
- Oculoplastics Institute, Division of Ophthalmology, Tel Aviv Sourasky Medical Center Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Ear, Nose and Throat Department, Tel Aviv Sourasky Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
A Killian–Jamieson diverticulum is a ‘false’ diverticulum on the lateral side of the proximal cervical esophagus. They are much rarer than Zenker diverticula and can be difficult to diagnose. They are best visualized using fluoroscopy studies, however, the workup for patients admitted with dysphagia can be sometimes extensive and unnecessary, leading to costly hospital stays, longer admissions and exposure to excessive radiation. Herein, we present a patient previously diagnosed with a Killian Jamieson diverticulum, who presented with worsening dysphagia, odynophagia and neck swelling, and was found to have an unusual inferior extension of the diverticulum. This paper will recognize the role of fluoroscopy in diagnosing diverticula and identifying causes of dysphagia, and to also recognize the use of American College of Radiology ‘ACR’ Appropriateness Criteria to minimize unnecessary studies.
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Affiliation(s)
- A Tagliaferri
- Department of Radiology, SKMC at Thomas Jefferson University, Philadelphia, PA, USA
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Burd C, Pai I, Pinto M, Dudau C, Connor S. Morphological comparison of internal auditory canal diverticula in the presence and absence of otospongiosis on computed tomography and their impact on patterns of hearing loss. Neuroradiology 2021; 63:431-437. [PMID: 33210164 PMCID: PMC7880953 DOI: 10.1007/s00234-020-02606-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/12/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE The association of internal auditory canal (IAC) fundal diverticula with otospongiosis (OS) and their clinical significance remain unclear. We explored whether isolated IAC diverticula were morphologically different from those with additional CT features of OS, and whether IAC diverticula morphology influenced patterns of hearing loss. METHODS Consecutive temporal bone CT studies with (n = 978) and without (n = 306) features of OS were retrospectively assessed. Two independent observers evaluated the presence of IAC diverticula morphological features (depth, neck:depth ratio, definition of contour and angulation of shape), and these were correlated with the presence of fenestral and pericochlear OS. Audiometric profiles were analysed for the isolated IAC diverticula and those with fenestral OS alone. Continuous data was compared using Wilcoxon rank sum tests and categorical data with chi-squared and Fisher's exact tests. RESULTS Ninety-five isolated IAC diverticula were demonstrated in 54/978 patients (5.5%) without CT evidence of OS (31M, 23F, mean age 46), and 119 IAC diverticula were demonstrated in 71/306 patients (23%) with CT evidence of OS (23M, 48F, mean age 55). Reduced neck:depth ratio, ill definition and angulation were all significantly associated with the presence of pericochlear OS (p < 0.001), whilst only ill definition was associated with the presence of fenestral OS alone (p < 0.05). No morphological feature was associated with conductive hearing loss in isolated diverticula or with sensorineural hearing loss in diverticula with fenestral OS alone. CONCLUSION IAC diverticula associated with pericochlear OS demonstrate different morphological features from isolated IAC diverticula. There are no clear audiometric implications of these morphological features.
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Affiliation(s)
- Christian Burd
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Irumee Pai
- Department of Otolaryngology, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK
- School of Biomedical Engineering & Imaging Sciences Clinical Academic Group, King's College London, London, SE1 9RT, UK
| | - Melisha Pinto
- Department of Oral Medicine and Radiology, Coorg Institute of Dental Sciences, Virajpet, Karnataka, India
| | - Cristina Dudau
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Steve Connor
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
- School of Biomedical Engineering & Imaging Sciences Clinical Academic Group, King's College London, London, SE1 9RT, UK.
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK.
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Yaginuma Y, Utano K, Utano Y, Nemoto D, Aizawa M, Matsuida H, Isohata N, Endo S, Togashi K. Diverticular hemorrhage of terminal ileum successfully treated by ultra-selective transcatheter arterial embolization using triaxial system: a case report. Clin J Gastroenterol 2021; 14:517-521. [PMID: 33403532 DOI: 10.1007/s12328-020-01328-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/13/2020] [Indexed: 12/22/2022]
Abstract
Small intestinal hemorrhage due to diverticulum is a relatively rare condition among gastrointestinal hemorrhages. We report a case of diverticular hemorrhage of the terminal ileum that was successfully treated by ultra-selective transcatheter arterial embolization using a triaxial system. A 25-year-old man was referred to our hospital due to melena. Abdominal contrast-enhanced computed tomography demonstrated marked extravasation of contrast medium in a diverticulum of the terminal ileum. We immediately attempted transcatheter arterial embolization after onset of hemorrhagic hypovolemic shock. Angiogram of the superior mesenteric artery revealed apparent hemorrhage at the end of the ileocolic artery. We performed embolization with 2 platinum coils using a triaxial system via the vasa recta of the terminal ileum. This procedure stopped extravasation of contrast medium. Postoperative course was uneventful, and he was discharged four days postoperatively. The triaxial system may facilitate high diagnostic ability to accurately identify target arteries of the ileal diverticular hemorrhage.
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Affiliation(s)
- Yuki Yaginuma
- Division of Radiology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, Fukushima, 969-3492, Japan
| | - Kenichi Utano
- Division of Radiology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, Fukushima, 969-3492, Japan. .,Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan.
| | - Yuka Utano
- Division of Radiology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, Fukushima, 969-3492, Japan
| | - Daiki Nemoto
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Masato Aizawa
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Hajime Matsuida
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Noriyuki Isohata
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Shungo Endo
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Kazutomo Togashi
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
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Kobayashi S, Sugiura K, Miyake H, Yuasa N, Yoshikawa K, Fujino M. Mucosal prolapse syndrome-like inflammatory polyp protruding from the appendiceal orifice masquerading as an appendiceal neoplasm: A rare case report. Clin J Gastroenterol 2021; 14:787-790. [PMID: 33386566 DOI: 10.1007/s12328-020-01302-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
We describe a case of a mucosal prolapse syndrome (MPS)-like inflammatory polyp protruding from the appendiceal orifice, mimicking an appendiceal neoplasm. A 48-year-old man presented with lower abdominal pain and elevated white blood cell count and C-reactive protein level. Computed tomography showed a swollen appendix with multiple small saccular lesions and periappendiceal fat stranding and small saccular lesions in the ascending colon and cecum. Ultrasonography showed a swollen appendix 25 mm in diameter with multiple saccular structures and a periappendiceal high-echoic area, suggesting appendiceal diverticulitis. Colonoscopy revealed an erythematous lesion protruding from the appendiceal orifice. An ileocecal resection was performed based on a preoperative diagnosis of appendiceal diverticulitis and tumor. Histopathological examination of the appendix showed multiple mucosal herniations with infiltration of inflammatory cells, indicating appendiceal diverticulitis. The tumor was characterized by glandular duct hyperplasia and stromal expansion with smooth muscle hyperplasia and was diagnosed as an inflammatory polyp resembling an MPS lesion. Although several studies have shown the macroscopic and endoscopic appearance of MPS-like inflammatory lesions associated with colonic diverticular disease, this case was the first to present an inflammatory polyp associated with appendiceal diverticulitis in which the lesion protruding from the appendiceal orifice was masquerading as an appendiceal neoplasm.
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Affiliation(s)
- Sumire Kobayashi
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Kota Sugiura
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Hideo Miyake
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Norihiro Yuasa
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan.
| | - Kanae Yoshikawa
- Department of Cytology and Molecular Pathology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Masahiko Fujino
- Department of Cytology and Molecular Pathology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
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Li L, Wang JJ. [Effect of laparoscopic modified with two different sutures on cesarean section incision]. Zhonghua Yi Xue Za Zhi 2020; 100:3784-7. [PMID: 33379843 DOI: 10.3760/cma.j.cn112137-20200510-01492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the effect of laparoscopic modified with two different sutures on the cesarean incision diverticulum repair. Methods: From July 2018 to July 2019, 35 patients with refertility requirements who were confirmed the diagnosis of caesarean incision diverticulum by hysteroscopy combined with ultrasound, and the muscle layer thickness at the top of diverticulum was less than 3 mm, received modified laparoscopic combined with hysteroscopic surgery in department of gynecological minimally invasive center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Ten patients with history of secondary repair and multiple pelvic operations were excluded. The remaining 25 patients were divided into group A (n=8): underwent laparoscopic "folding suture" , preserving the integrity of the diverticulum of the cesarean incision; Group B (n=17): underwent laparoscopic incision and complete excision of the scar of the diverticulum. The operation time, bleeding volume, postoperative exhaust time, improvement of symptoms and the thickness of muscle layer were compared between the two groups. Results: All patients underwent surgery without complications. 25 patients were followed up one month, three months and half a year after operation, and followed up by telephone for 6-18 months. The operation time of group A and B was (56±12) min, (72±15) min, and the bleeding volume was (40±9) ml and (66±10) ml respectively. The cure rate was 87.5% and 58.8% respectively, the differences were statistically significant (t=6.778, 4.057, χ(2)=5.651, P<0.05). But the postoperative exhaust time was (16±6) h, (18±7) h, and the effective rate was 100.0% and 94.1% respectively, with no significant difference(t=1.967, χ(2)=0.725, P>0.05). Conclusion: Two different suture repair methods under laparoscope are safe and effective for the treatment of diverticulum in cesarean section incision. Among them, the laparoscopic "folding suture" method has a short operation time and preserves the integrity of the myometrium. It is worth popularizing for the elderly patients who has an urgent need for fertility.
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Tsai MC, Lee CT, Wang WL. An Unusual Cause of Dysphagia. Gastroenterology 2021; 160:e17-e18. [PMID: 32504639 DOI: 10.1053/j.gastro.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/01/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Ming-Chang Tsai
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ching-Tai Lee
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Wen-Lun Wang
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
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Takatori Y, Kato M, Nakayama A, Yahagi N. A Case of Duodenal Tumor Adjacent to the Diverticulum That Was Resected by the Technique of Partial Submucosal Injection Combined with Underwater Endoscopic Mucosal Resection. Dig Dis 2021; 39:70-74. [PMID: 32526738 PMCID: PMC7949217 DOI: 10.1159/000509323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/03/2020] [Indexed: 02/02/2023]
Abstract
A 66-year-old male was referred to our hospital for treatment of duodenal tumor. The most difficult part was that the lesion was adjacent to duodenal diverticulum. Endoscopic mucosal resection (EMR) was difficult because submucosal injection spread broadly and quickly and makes it difficult to visualize the diverticulum edge of the lesion. Simple underwater EMR (UEMR) had risk for perforation at the diverticulum part because duodenal diverticulum is spurious diverticulum that defects the proper muscle layer. Therefore, to make sufficient distance between diverticulum and the lesion, we performed partial submucosal injection into only the diverticulum side of the lesion combined with simple UEMR. The lesion was resected en bloc without any adverse events. Histopathological diagnosis was tubular adenoma with moderate atypia and surgical margin negative. Partial submucosal injection combined with simple UEMR might be useful for duodenal tumor that has any technical difficulties as in this case.
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Affiliation(s)
| | - Motohiko Kato
- *Motohiko Kato, Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582 (Japan),
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Rkik M, Elidrissi O, Jandou I, Dakir M, Debbagh A, Aboutaieb R. A rare entity of bilateral hutch diverticulum asymptomatic in adult revealed during the assessment of hematuria. Urol Case Rep 2020; 35:101530. [PMID: 33365253 PMCID: PMC7749431 DOI: 10.1016/j.eucr.2020.101530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022] Open
Abstract
Hutch diverticulum is a rare congenital entity that develops in the ureteral hiatus or in its proximity and is accompanied by reflux in most cases. There are very few reported cases and most of them are in children and predominately at solitary side. Adult cases are rare. We review the literature and present a case of a 65-year-old man with bilateral hutch diverticulum asymptomatic revealed during assessment of hematuria.
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Affiliation(s)
- Mustapha Rkik
- Urology Department, CHU Ibn Rochd, Casablanca, Morocco.,Faculté de Médicine et de Pharmacie, Casablanca, Morocco
| | - Oussama Elidrissi
- Urology Department, CHU Ibn Rochd, Casablanca, Morocco.,Faculté de Médicine et de Pharmacie, Casablanca, Morocco
| | - Issam Jandou
- Urology Department, CHU Ibn Rochd, Casablanca, Morocco.,Faculté de Médicine et de Pharmacie, Casablanca, Morocco
| | - Mohammed Dakir
- Urology Department, CHU Ibn Rochd, Casablanca, Morocco.,Faculté de Médicine et de Pharmacie, Casablanca, Morocco
| | - Adil Debbagh
- Urology Department, CHU Ibn Rochd, Casablanca, Morocco.,Faculté de Médicine et de Pharmacie, Casablanca, Morocco
| | - Rachid Aboutaieb
- Urology Department, CHU Ibn Rochd, Casablanca, Morocco.,Faculté de Médicine et de Pharmacie, Casablanca, Morocco
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Shakerian B, Mandegar MH. Right Atrial Diverticulum in an Adult Woman with Left Bundle Branch Block. Sultan Qaboos Univ Med J 2020; 20:e394-e396. [PMID: 33414948 PMCID: PMC7757933 DOI: 10.18295/squmj.2020.20.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/08/2020] [Accepted: 06/24/2020] [Indexed: 11/24/2022] Open
Abstract
Right atrial diverticulum is a very rare anomaly. It is an outpouching arising from the right atrial free wall. Clinical presentations vary widely but some cases are associated with supraventricular tachycardia and atrial flutter/fibrillation. The incidence/prevalence of this anomaly is not available because only a few cases have been reported. We report a 38-year-old female patient who presented to the Heart Clinic, Tehran, Iran in 2019 with a history of dyspnea and chest pain. Electrocardiography revealed left bundle branch block. Following a magnetic resonance imaging study, the patient was diagnosed with a right atrial diverticulum. She underwent surgical resection of the diverticulum. The post-operative course was uneventful and no recurrence of the arrhythmia was detected during the six months of follow-up. To the best of the authors’ knowledge, this combination has not been described in the literature.
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Affiliation(s)
- Behnam Shakerian
- Department of Cardiovascular Surgery, Tehran University of Medical Sciences, Tehran, Iran.,Department of Cardiovascular Surgery, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mohammad H Mandegar
- Department of Cardiovascular Surgery, Tehran University of Medical Sciences, Tehran, Iran
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Dávila-Ruiz EO, García-Manzano RA, Barker-Antonio A, Martínez-Santiago NY, Isidoro-Hernández D, Sánchez-Guerrero RI. Ictericia obstructiva intermitente o síndrome de Lemmel: reporte de caso y revisión de la literatura. CIR CIR 2020; 88:60-65. [PMID: 33284277 DOI: 10.24875/ciru.20000332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Se presenta el caso de una paciente de 68 años con un cuadro de colangitis recurrente y presencia de divertículo duodenal que comprime la vía biliar. El síndrome de Lemmel es una afección infrecuente en la literatura, debido a que los divertículos duodenales rara vez presentan síntomas (10%) y en general se diagnostican de manera incidental. El 75% de estos divertículos son periampulares. Si se localizan a 2.5 cm del ámpula de Vater son yuxtapapilares. Solo el 1% presentan complicaciones. Debe ser considerado en caso de ictericia intermitente y colangitis, y tenerlo en cuenta como diagnóstico diferencial de pseudoquistes, tumor de cabeza de páncreas o metástasis. We present the case of a 68-year-old patient with recurrent cholangitis and the presence of a duodenal diverticulum that compresses the bile duct. Lemmel syndrome is a rare entity reported in the literature, because duodenal diverticula rarely have symptoms (10%) and are usually diagnosed incidentally, 75% of these diverticula are periampullary, if they are located within 2.5 cm from the Vater ampule are juxtapapillary. Only 1% present complications. It should be considered in case of intermittent jaundice, cholangitis, as a differential diagnosis of psuedocysts, pancreatic head tumor or metastases.
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Affiliation(s)
- Ediel O Dávila-Ruiz
- Servicio de Cirugía General, Hospital Regional de Alta Especialidad de Oaxaca, Secretaría de Salud Oaxaca, San Bartolo Coyotepec, Oaxaca. México
| | - Roberto A García-Manzano
- Servicio de Cirugía General, Hospital Regional de Alta Especialidad de Oaxaca, Secretaría de Salud Oaxaca, San Bartolo Coyotepec, Oaxaca. México
| | - Alan Barker-Antonio
- Servicio de Cirugía General, Hospital Regional de Alta Especialidad de Oaxaca, Secretaría de Salud Oaxaca, San Bartolo Coyotepec, Oaxaca. México
| | - Nallely Y Martínez-Santiago
- Servicio de Cirugía General, Hospital General Sur Puebla "Dr. Eduardo Vásquez Navarro", Puebla, Puebla. México
| | - Dolores Isidoro-Hernández
- Servicio de Cirugía General, Hospital Regional de Alta Especialidad de Oaxaca, Secretaría de Salud Oaxaca, San Bartolo Coyotepec, Oaxaca. México
| | - Rolando I Sánchez-Guerrero
- Servicio de Cirugía General, Hospital Regional de Alta Especialidad de Oaxaca, Secretaría de Salud Oaxaca, San Bartolo Coyotepec, Oaxaca. México
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Miutescu BP, Khan S, Mony S, Khashab MA. Role of Peroral Endoscopic Myotomy (POEM) in the Management of Esophageal Diverticula. Clin Endosc 2020; 53:646-651. [PMID: 33238358 PMCID: PMC7719426 DOI: 10.5946/ce.2020.262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 11/05/2020] [Indexed: 01/10/2023] Open
Abstract
Esophageal diverticula are uncommon; however, when present, they can cause symptoms of dysphagia, regurgitation, and chest pain. Based on location and pathophysiological characteristics, they are classified as pulsion- and traction-type diverticula. In the past, the open surgical approach was the only treatment available; however, in the past few decades, transoral incisionless approaches in the form of rigid and flexible endoscopy have gained popularity. Diverticular peroral endoscopic myotomy has emerged as an alternative treatment option. In this paper, we reviewed the role of peroral endoscopic myotomy as a treatment option for different types of esophageal diverticula. Although a safe and effective procedure, this novel submucosal tunneling technique for the treatment of esophageal diverticula requires further validation, and head-to-head comparisons between the different approaches for the treatment of esophageal diverticula are warranted.
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Affiliation(s)
- Bogdan P Miutescu
- Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
| | - Sarah Khan
- Department of Medicine, Saint Agnes Hospital, Baltimore, MD, USA
| | - Shruti Mony
- Department of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Mouen A Khashab
- Department of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, MD, USA
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Zhao P, Ding H, Lv H, Li X, Qiu X, Zeng R, Wang G, Wei J, Jin L, Yang Z, Gong S, Wang Z. CT venography correlate of transverse sinus stenosis and venous transstenotic pressure gradient in unilateral pulsatile tinnitus patients with sigmoid sinus wall anomalies. Eur Radiol 2021; 31:2896-902. [PMID: 33128184 DOI: 10.1007/s00330-020-07415-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/30/2020] [Accepted: 10/13/2020] [Indexed: 12/18/2022]
Abstract
Objectives To investigate the correlation between transverse sinus stenosis (TSS) and transstenotic pressure gradient (TPG) in unilateral pulsatile tinnitus (PT) patients with sigmoid sinus wall anomalies (SSWA). Methods Fifty-seven patients with unilateral venous PT were retrospectively included. All of them underwent CT venography and catheter manometry, accompanied with SSWA. The degree, length, shape (intrinsic/extrinsic/dysplasia), location (proximal/middle/distal, referring to the relative position of TSS and the Labbé vein junction) of TSS, the types of SSWA (dehiscence/diverticulum), and the degree of transverse sinus outflow laterality were assessed, and the correlations with ipsilesional TPG were analyzed. Results The mean value of ipsilesional TPG was 7.61 ± 0.52 mmHg. The degree and length of ipsilesional TSS were positively correlated with TPG (p < 0.001, p’ < 0.001), respectively. TPG was significantly larger in patients with contralateral transverse sinus dysplasia than those without (p = 0.023) and significantly smaller in patients with ipsilesional sigmoid sinus diverticulum than those with isolated dehiscence (p = 0.001). No statistical difference in TPG was shown between ipsilesional TSSs of different shapes or locations (p > 0.05). No correlation was noted between the degree of ipsilesional transverse sinus outflow laterality and TPG (p = 0.051). Stepwise linear regression indicated that the degree (β = 9.207, 95% CI = 3.558–14.856), length (β = 0.122, 95% CI = 0.025–0.220) of ipsilesional TSS, and contralateral transverse sinus dysplasia (β = 1.875, 95% CI = 0.220–3.530) were significantly correlated with TPG (R2 = 0.471). Conclusions The degree, length of ipsilesional TSS, and contralateral transverse sinus dysplasia may be used to predict TPG in unilateral PT patients with SSWA. Key Points • CT venography may act as a screening tool to help low-probability unilateral pulsatile tinnitus (PT) patients with sigmoid sinus wall anomalies (SSWA) avoid invasive catheter manometry. • The degree and length of ipsilesional transverse sinus stenosis (TSS) are positively correlated with transtenotic pressure gradient (TPG) in unilateral PT patients with SSWA. • Ipsilesional TPG is larger in unilateral PT patients with contralateral transverse sinus dysplasia than those without and is smaller in unilateral PT patients with sigmoid sinus diverticulum than those with isolated dehiscence.
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Abstract
OBJECTIVES The disruption or defect of the myometrium in the uterine scar of a cesarean section (CS) has been known by various names, such as uterine niche, isthmocele, deficient uterine scar, scar pouch, or diverticulum. Symptomatology, risk factors for niche development, and available treatment modalities have been recently studied. However, the histologic features of this disease remain unknown. METHODS The histologic features of eight uterine niches are thoroughly described and a summary of the most important aspects of the uterine niche literature is provided. Five cases of CS scars without niche formation are comparatively examined. RESULTS Most uterine niches harbor endocervical mucosa, often cystically dilated and/or an atrophic or disorganized endometrial mucosa of lower uterine segment origin. Regenerative epithelial atypia and fibroblastic stromal reaction are frequent features. No granulomatous reaction, important inflammation, or hemorrhage is seen. CS scars without niche formation do not harbor endocervical mucosa or inclusion cysts, fibroblastic stroma, or regenerative atypia. CONCLUSIONS As more prospective studies of uterine niche development and treatment will be conducted, a detailed pathologic report with the criteria proposed herein can be designed.
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Affiliation(s)
| | - Celine Chauleur
- Gynecology and Obstetrics Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | | | | | - Thomas Corsini
- Gynecology and Obstetrics Department, University Hospital of Saint-Etienne, Saint-Etienne, France
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Ethiraj D, Kumar SD, Indiran V, Maduraimuthu P. Imaging of Pharyngocele: An Occupational Overuse Syndrome. Oman Med J 2020; 35:e181. [PMID: 33083039 PMCID: PMC7568824 DOI: 10.5001/omj.2020.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 08/19/2019] [Indexed: 11/05/2022] Open
Abstract
Pharyngocele is a rare pathology of the pharynx caused by the laxity of the thyrohyoid membrane. Only about 60 true lateral pharyngocele cases have been reported in the literature over the last 133 years. Laryngocele is a close differential, and the two are difficult to tell apart. Though they have been described well in the literature, they are often misdiagnosed or interchangeably diagnosed. The acquired type of pharyngocele is due to prolonged increased intrapharyngeal pressure and pharyngeal wall weakness, and it is more common than congenital pharyngoceles. Close differential diagnoses include Zenker’s diverticulum, laryngocele, and jugular venous phlebectasia. Acquired lateral pharyngoceles are seen in wind instrument musicians and glassblowers. Hence, these diverticula are described as ‘overuse syndrome’. We present a case of bilateral neck swelling, which occurred doing the Valsalva maneuver with imaging studies.
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Affiliation(s)
- Dillibabu Ethiraj
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chennai, India
| | - Suresh D Kumar
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chennai, India
| | - Venkatraman Indiran
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chennai, India
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Wang LR, Shi XY, Du J, Li F, Tong F. [Appendiceal diverticulosis, a potential mimic of low grade appendiceal mucinous neoplasm: analysis of 20 cases]. Zhonghua Bing Li Xue Za Zhi 2020; 49:891-6. [PMID: 32892553 DOI: 10.3760/cma.j.cn112151-20191231-00840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To study the clinicopathologic features and the key points of differential diagnosis of appendiceal diverticulosis (AD) and low-grade mucinous neoplasm (LAMN) to avoid over-diagnosis. Methods: The clinical data, pathologic features and follow-up information of 20 patients with AD, who were diagnosed in the Peking University Third Hospital from January 2010 to November 2019 were collected and compared with 44 cases of LAMN which were diagnosed during the same period. Results: Among the 20 cases of AD, hypermucinous epithelium, filiform villi or undulating epithelium and mucosa atrophy were observed in 10 (50.0%), 4 (20.0%) and 14 (70.0%) cases, respectively, however, focally loss of lamina propria and mucosa/submucosa fibrosis were observed only in 1 (5.0%) and 4 (20.0%) cases, respectively. Extramural mucin deposits were seen in 11 (55.0%) cases, all were acellular mucin. Mucosal Schwann cell hyperplasia were present in 12 (60.0%) cases. Nine (45.0%) and 5 (25.0%) cases were associated with acute diverticulitis or acute suppurative appendicitis, respectively. In comparison with AD, LAMN cases more frequently showed hypermucinous epithelium (42/44, 95.5%), filiform villi or undulating epithelium (43/44, 97.7%), loss of lamina propria (43/44, 97.7%) and fibrosis and hyalinization of appendiceal wall (44/44, 100.0%), whereas mucosal atrophy (4/44, 9.1%) and Schwann cell hyperplasia(11/44, 25.0%) were less frequently seen (P<0.05). Follow-up information was available for 10 AD patients and 27 LAMN patients; all were alive without evidence of recurrence. Conclusions: Epithelial hyperplasia, loss of lamina propria, fibrosis of the appendiceal wall and extramural mucin deposits may occur focally in AD and should be distinguished from LAMN. The preservation of normal appendiceal mucosa architecture, lack of diffuse appendiceal wall fibrosis and hyalinization, and no definite neoplastic epithelium are the key point for preventing over-diagnosis.
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Sudarshan M, Fort MW, Barlow JM, Allen MS, Ravi K, Nichols F, Cassivi SD, Wigle DA, Shen RK, Blackmon SH. Management of Epiphrenic Diverticula and Short-term Outcomes. Semin Thorac Cardiovasc Surg 2020; 33:242-246. [PMID: 32853738 DOI: 10.1053/j.semtcvs.2020.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/20/2020] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- Monisha Sudarshan
- Division of Cardiovascular and Thoracic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Michael W Fort
- Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - John M Barlow
- Division of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Mark S Allen
- Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Karthik Ravi
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota
| | - Francis Nichols
- Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Dennis A Wigle
- Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Robert K Shen
- Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
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Lask A, Rappaport YH, Neheman A, Zisman A, Beberashvili I, Stav K. Transvaginal surgical repair of large urethral diverticula with bipedicle double-opposing flaps of the periurethral fascia. Int Urogynecol J 2020; 32:2969-2973. [PMID: 32797263 DOI: 10.1007/s00192-020-04486-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 07/30/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The aims of this study were to describe a novel technique for transvaginal repair of large (> 4 cm) female urethral diverticulum (UD) using bipedicle double-opposing flaps of the periurethral fascia and to evaluate long-term follow-up. METHODS The medical records of 29 women who underwent transvaginal excision of UD at our institution were reviewed retrospectively. Seventeen cases with UD > 4 cm were included in the study. Cystourethroscopy was performed at the beginning of the surgery, and in 60% of cases the orifice of the diverticulum was identified. An inverted-U incision was performed at the vaginal anterior wall. The periurethral fascia was incised longitudinal at the midline and parallel to the urethra. The diverticular sac was dissected and resected. The neck of the diverticulum was closed with 4/0 vicryl suture. The periurethral fascia was sutured using bipedicle double-opposing flaps with interrupted 3/0 vircyl suture. The vaginal mucosa was sutured with 2/0 vicryl continuous suture. RESULTS All 17 women with large UD were operated on using bipedicle double-opposing flaps of the periurethral fascia. Follow-up of 5 ± 2.4 years yielded no recurrence and no other late complications. CONCLUSION Using bipedicle double-opposing flaps of the periurethral fascia during transvaginal excision of large UD is safe and effective.
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Affiliation(s)
- Avigal Lask
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), 7030000, Zerifin, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yishai Hode Rappaport
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), 7030000, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Neheman
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), 7030000, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amnon Zisman
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), 7030000, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilia Beberashvili
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology, Shamir Medical Center (Assaf Harofeh Campus), Zerifin, 7030000, Israel
| | - Kobi Stav
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), 7030000, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Yamamoto K, Shiratori Y, Ikeya T. Utility of the Gel Immersion Method for Treating Massive Colonic Diverticular Bleeding. Clin Endosc 2020; 54:256-260. [PMID: 32777918 PMCID: PMC8039735 DOI: 10.5946/ce.2020.081] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/09/2020] [Indexed: 12/29/2022] Open
Abstract
Background/Aims In Asia, right-sided diverticular bleeding is more common than that of the left side. It often causes massive bleeding and difficulties in identifying the stigmata of recent hemorrhage (SRH) of colonic diverticular bleeding (CDB). This case series demonstrates the efficacy of the gel immersion method using OS-1 Jelly (Otsuka Pharmaceuticals Factory, Tokushima, Japan) in patients with CDB.
Methods This retrospective case series analyzed data of patients with CDB who underwent the gel immersion method from April 2016 to February 2020 at St. Luke’s International Hospital, Japan. All patients diagnosed with CDB who underwent the gel immersion method were included. We collected data on the site of bleeding, identification of SRH, and efficacy of the method from the electronic medical records.
Results A total of 9 patients (including 7 with right-sided CDB) underwent gel immersion method and were included in this study. SRH were successfully found in 66.7% (6/9) of patients. Moreover, effective hemostasis was achieved in 85.7% (6/7) of patients with right-sided CDB. There were no adverse events.
Conclusions The gel immersion method was found to be effective, especially for massive right-sided CDB.
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Affiliation(s)
- Kazuki Yamamoto
- Division of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Yasutoshi Shiratori
- Division of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Takashi Ikeya
- Division of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
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