Unusual gastric deverticula. Report of two cases.

Abstract

The radiographic diagnosis of gastric diverticulum was first made by Brown (3) in 1916. By 1958, a total of 469 cases had been reported (6, 8, 9, 12). Of all the organs of the gastrointestinal tract, the stomach is least often affected by diverticula, with fewer than 0.05 per cent of those found on routine gastrointestinal examination (8). In Palmer's series of 342 cases (8), 75 per cent occurred in the juxtacardiac region, 25 per cent in the prepyloric region, and less than 3 per cent arose from the greater curvature of the antrum or from the greater curvature of the pars media of the stomach. Presented herein are two cases of gastric diverticula in unusual locations. Case I: R. F., a 60-year-old woman, complained of pressure in the epigastrium, belching, and dysphagia relieved only by self-induced vomiting—all symptoms of several years duration. There was no significant weight loss, change of bowel habits, hematemesis, or melena. On physical examination, the findings were normal except for a palpable left flank mass. Laboratory studies included a complete blood count and a urinalysis with normal findings. Gastric analysis revealed a free hydrochloric acid of 0.3 units by the tubeless method. X-ray Studies: Intravenous pyelography and nephrotomography demonstrated findings consistent with a large cyst of the lower pole of the left kidney. The upper gastrointestinal series showed a small collection of barium thought to represent a small ulcer crater of the greater curvature aspect of the gastric antrum (Fig. 1), a finding confirmed by re-examination two days later (Fig. 2). On exploratory laparotomy two weeks later, a large benign cyst of the left kidney was removed. Exploration of the outer surface of the stomach revealed no abnormality, but when a gastrostomy was made on the anterior wall of the stomach and the greater curvature was examined, the inner opening of a small diverticulum was seen. The diverticulum was contained entirely within the wall of the stomach. It was inverted and amputated, and the mucosa was closed with running catgut suture. Postoperatively the patient did well. Case II: A. B., a 66-year-old white female, had no gastrointestinal complaints, nor were there any clinical findings. Upper gastrointestinal x-ray studies, a part of a routine physical examination, however, demonstrated a small collection of barium extending from the greater curvature aspect of the pars media of the stomach. This barium shadow appeared to change in shape and size, depending upon position of the patient, pressure by the examiner, and peristalsis of the stomach (Figs. 3 and 4). Because of changes in shape, the radiographic diagnosis of gastric diverticulum was made. Three weeks later the patient underwent a second gastrointestinal examination in which exactly similar findings were noted.