Combined Laparoscopic–Endoscopic Technique for Gastric Diverticulectomy

Abstract

Purpose: Gastric diverticula are rare manifestations of diverticular disease, accounting for 3% of all diverticula. Methods: We present the case of a 17-year-old male who presented with complaints of epigastric fullness, reflux, and early satiety. He was given a trial of proton pump inhibitors with minimal improvement. A contrast swallow study showed an irregularity at the gastric fundus. A gastric diverticulum was confirmed on endoscopy and the patient was referred to surgery. Resection was planned because of symptomatology. Utilizing laparoscopic–endoscopic rendezvous technique, the posterior lying diverticulum was resected. A nasogastric tube was placed postoperatively and the patient was kept nil per os for 24 hours. He was advanced to a diet and discharged home on postoperative day 3. At follow-up he has no complaints. Results: Gastric diverticula are uncommon manifestations of diverticular disease. These lesions have equal incidence in males and females and occur in pediatric patients only rarely, 4%. Gastric diverticula may be congenital or acquired. Congenital gastric diverticula are true diverticula, occurring posteriorly within 2–3 cm of the gastroesophageal junction and are thought to arise from a defect in the gastric wall musculature. Patients with congenital diverticula are often asymptomatic or present with vague abdominal complaints, thought to be because of their location and broad base. Emergency complications include bowel obstruction, perforation, or bleeding. Oral contrast swallow studies and upper endoscopy provide the most reliable diagnosis; however, many patients will undergo CT or ultra sound imaging because of their vague complaints, and these lesions are often confused for splenic, adrenal, or pancreatic pathologies. Conclusion: Gastric diverticula are rare congenital abnormalities in pediatric populations. Resection is recommended for resolution of symptoms. A laparoscopic–endoscopic rendezvous procedure allows for adequate identification and observation of the lesion. No competing financial interests exist. Runtime of video: 3 mins 16 secs A version of this video was previously presented at the American College of Surgeons Meeting in Washington DC, October 19, 2016.