Gastric Diverticulum Research Articles

Gastric Diverticulum: A Case Report with a Brief Literature Review

Gastric diverticula are the rarest type of diverticula detected in the gastrointestinal tract. With possible forms of congenital or acquired origin, it shows no gender predominance and is commonest in the ages of 50-70 years. Here, we report a case of gastric diverticulum detected in a 48-year-old female presenting with symptoms of dyspepsia and early satiety. The gastric diverticulum was detected during upper gastrointestinal endoscopy, which was further defined by an upper gastrointestinal contrast study. The patient recovered after two weeks of treatment with a proton pump inhibitor and a prokinetic, counselled regarding possible complications and advised to be reviewed if symptoms recur. Although gastric diverticula are rare, this can worsen with ulceration, bleeding, perforation, and malignant transformation. This emphasizes how crucial it is to identify and comprehend this condition in order to provide patients with the proper care and follow-up.

SPECT/CT in the Diagnosis of Ectopic Gastric Mucosa-Meckel's Diverticulum.

Aim The imaging of Meckel's diverticulum (MD) is based of accumulation of Tc-99m pertechnetate in the ectopic gastric mucosa (EGM) content. Although the diagnostic accuracy of this imaging modality is high, there are some overlap patients with coexisting gastrointestinal bleeding and false positive causes hampering diagnostic power. The aim of this study was to evaluate the possible contribution of single-photon emission computed tomography/computed tomography (SPECT/CT) in EGM-MD diagnosis and to determine the indication of this additional imaging modality. Materials and Methods Fifty-two pediatric patients (24 girls, 28 boys; mean age: 8.06 ± 5.22 years old) who have suspicion of MD and referred for scintigraphy were evaluated retrospectively. Additional SPECT/CT were performed to selected five cases among the group. The results of the scintigraphy as well as SPECT/CT were compared with endoscopy, pathology, and/or follow-up results. Results There were 9 patients with equivocal study results, 12 positive results, and the others were considered negative MD scintigraphy. One patient was out of follow-up and 10 patients underwent surgery. Only one single patient was negative during surgery but scintigraphy was also negative. The diagnostic sensitivity, specificity, and accuracy were 100, 95, and 96%, respectively. Among five patients with SPECT/CT results one patient was diagnosed by only SPECT/CT who had EGM in duplication cyst, one equivocal patient was diagnosed as descending colon bleeding, and one patient's lesion was clearly delineated by SPECT/CT. Conclusion SPECT/CT has clear advantage over standard planar scintigraphy imaging in EGM-MD determination. This modality might decrease equivocal and false positive results but this issue has to be addressed with further studies.

Endoscopic Finding of Large Gastric Diverticulum with Ulceration: A Rare Cause of Upper Gastrointestinal Bleeding

Endoscopic Finding of Large Gastric Diverticulum with Ulceration: A Rare Cause of Upper Gastrointestinal Bleeding

A case series of gastric diverticulum masquerading as adrenal adenoma

A case series of gastric diverticulum masquerading as adrenal adenoma

Gastric diverticulum: a contemporary review and update in management.

Gastric diverticula (GD) are the rarest form of gastrointestinal tract diverticulum, with an estimated incidence of 0.013-2.6%. GD are poorly understood and there are no established management guidelines. Only sparse updates have been published since the mid-20th century. This paper reviews the current literature and provides some suggested guidelines for the management of GD. A search of Medline via OvidSP and Google Scholar for 'gastric diverticulum' and associated synonyms from the year 1950 onwards was performed. We included randomized controlled trials (RCTs), cohort and case-control studies, and case series. Full text, English language manuscripts on adult populations were included. A total of 103 manuscripts were included in the final selection - 77 individual case studies, 23 case series and three reviews. No RCTs, cohort or case-control studies were found. The case studies represent 305 patients, 50.8% female with average age 49.2 years (range 18-80). The most common symptom was abdominal pain (48.2%). The average maximum diameter was 3.97 cm (range 0.5-9). One hundred and four patients were managed operatively. Despite persistent recommendations in the literature that GD > 4 cm should be considered for resection, there are no data supporting this approach. The evidence pertaining to the management of GD is sparse. The decision for operative management should be individualized and based primarily on the presence of symptoms or complications which may be directly attributable to the GD. Where surgery is indicated, a laparoscopic approach, potentially with intra-operative gastroscopy, is appropriate.

Implications of Gastric Diverticulum in the Incidence of Metaplasia: An Analysis of 37 Cases

Aim: The present study aimed to investigate the potential association between gastric fundus diverticulum and metaplasia by retrospectively analysing patient data and biopsy results.
 Material and Methods: 37 patients with gastric fundus diverticulum were examined, with their data compared to a control group of 50 patients without it. All diagnoses were made endoscopically. Demographic information, laboratory parameters, and endoscopic biopsy results were compared between the groups.
 Results: No significant differences were identified between the two groups concerning several laboratory parameters. However, there were significant differences in lymphocytes, urea, albumin, Na, and K values (p0.05), while a notable difference was seen in the distribution of metaplasia (p

Management of Large Subcardial Diverticula in Sleeve Gastrectomy: Technical Tips

Gastric diverticula are uncommon anatomic abnormalities that are usually asymptomatic or found incidentally in upper gastrointestinal radiographs with contrast or endoscopy. Gastric diverticula usually arise from the wall of the gastric fundus. Their preoperative study or intraoperative finding is of great importance in patients with obesity who are scheduled for bariatric surgery. In bariatric surgery, and especially in sleeve gastrectomy, it is of utmost importance to know the exact location of the diverticulum in order to position the stapler correctly and to perform appropriate gastric resection including the diverticulum. Sleeve gastrectomy has gained popularity worldwide and currently accounts for the most performed bariatric procedure according to more recent international surveys. It is considered to be a technically easy procedure. Nonetheless, some steps of the procedure, such as gastric fundus mobilization and the gastric resection with the use of the stapler, may be challenging in patients with a high BMI and in the presence of abnormalities of the gastric wall. This can represent a risk for the occurrence of complications such as a gastric leak or bleeding. We propose some considerations about technical tips to adopt for safely performing sleeve gastrectomy in the presence of a subcardial diverticulum.

Successful Clip Hemostasis for Ulcer Bleeding in a Large Gastric Diverticulum.

Successful Clip Hemostasis for Ulcer Bleeding in a Large Gastric Diverticulum.

A rare case of Gastric Diverticulum in a young patient

A rare case of Gastric Diverticulum in a young patient

Multimodality Approach To Diagnose Gastric Diverticulum : A Rare Cause Of Acute Abdomen

Gastric Diverticulum (GD) is a rare form of diverticular disease where it is defined as out-pouching of gastric wall. Majority of patients are asymptomatic but it may present with variable symptoms mimicking other diseases. We report a case of GD mimicking sealed perforated gastric ulcer based on clinical presentation and Contrast-Enhanced Computed Tomography (CECT) abdomen images.

S2659 Splenic Artery Pseudoaneurysm as a Rare Cause of Upper Gastrointestinal Bleeding

Introduction: Upper gastrointestinal bleeding (UGIB) is one of the most common causes for hospital admission in the US. Common etiologies for UGIB include peptic ulcer disease, erosive esophagitis, varices, and less commonly malignancies. Splenic artery pseudoaneurysm (PSA) is a known complication of pancreatitis. It may be asymptomatic or present with left upper quadrant or epigastric pain, and rarely as hemorrhagic shock. Splenic artery PSA presenting with UGIB is extremely unusual. Case Description/Methods: We present the case of a 57-year-old male with alcohol use disorder complicated by a prior episode of alcoholic pancreatitis, who presented with 3 days of hematemesis, melena, and recurrent syncopal episodes. In the ED his vitals and physical exam were notable for tachycardia, hypotension, and melena. Labs revealed a hemoglobin of 4.2. Non-contrast CT of the abdomen and pelvis showed evidence of blood in the antrum and a 2.0 x 1.6 cm out-pouching from the greater curvature of the stomach which was postulated to be a gastric diverticulum (image 1). Upper endoscopy revealed fresh blood in the antrum and duodenum, as well as a massive adherent clot in the fundus. Since no single site of active bleeding was identified, the patient was started on IV PPI with continued close monitoring in the ICU. He continued to have melena, and increased PRBC requirements. Repeat EGD was performed but was unchanged from prior. A CT angiogram of the abdomen and pelvis demonstrated a 1.5 cm actively bleeding PSA arising from a first divisional branch of the splenic artery communicating with the fundus of the stomach (images 2 & 3). The patient underwent successful coil embolization (image 4). Hemoglobin remained stable throughout the remainder of his admission with no further evidence of bleeding. Discussion: This case demonstrates PSA as a rare cause of UGIB. Lesions are most commonly caused by chronic pancreatitis, pancreaticobiliary surgery, and trauma. This patient’s PSA was likely secondary to his prior episode of alcoholic pancreatitis. Prompt diagnosis of PSA is essential given the high mortality rate associated with rupture. Clinicians should maintain a high index of suspicion for gastrointestinal PSA in patients with a history of pancreatitis who present with UGIB for whom no obvious source of bleeding can be identified on endoscopy.Figure 1.: CT Thx/Abd/Pel demonstrating a 2.0 x 1.6 cm out-pouching from the greater curvature of the stomach (arrow), postulated to be a gastric diverticulum, 2. CT Angiogram Abd/Pel demonstrating the splenic artery PSA (arrow), 3. Fluoroscopic imaging re-demonstrating the splenic artery PSA with extravasation of contrast into the gastric lumen, 4. Splenic Artery PSA after successful coil embolization.

S3605 Gastrointestinal Stromal Tumor Presenting as a Fistulizing Cavitary Lesion

Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the stomach. GISTs can vary from small, asymptomatic lesions managed with surveillance to large lesions presenting with life-threatening complications, including gastrointestinal hemorrhage. Complications such cavitary lesions and luminal GI fistulas have been reported but are exceedingly rare. Case Description/Methods: A 65 year-old woman developed mild, constant abdominal pain. Her past medical history includes HTN, GERD, COPD and 50 pack-year smoking history. One month after symptom onset, she was admitted to an outside hospital with upper GI bleed. EGD was reportedly normal at that time. She was readmitted one month later with recurrent anemia. CT scan showed a large gastric diverticulum or possible cavitary lesion. EGD was repeated and showed an opening to a large diverticulum or cavity distal to the gastroesophageal junction with ulcerated cavity wall. Pathology showed ulcerated gastric mucosa and granulation tissue with atypical spindle cells. Biopsies were negative for H. pylori. She was then admitted to our hospital for severe anemia and work-up of suspected GIST. A third EGD showed a 2 cm fistula to a 10 cm necrotic cavity on the fundus and proximal greater curvature of the gastric body. Multiple biopsies of the cavity wall were taken. Biopsies were positive for spindle cell-type GIST (CD117+, CD34+, Cam 5.2-). She then had a feeding jejunostomy placed due to difficulty tolerating PO intake. She was treated with pantoprazole and imatinib and discharged with Medical Oncology and Surgery follow-up for resection. (Figure) Discussion: The most common site of origin for GISTs is the stomach. Radiographic appearance is variable and can include endoluminal, exophytic or dumbbell-shaped pattern and there is frequently necrosis. Other imaging findings include calcifications, cyst formation, cystic degeneration and rarely, cavitary lesions and fistulas. In fact, there are only 2 case reports in the last 10 years of GISTs presenting as a gastric fistula or a gastrobronchial fistula. CT findings including: hemorrhage, necrosis, calcifications, intralesional cavitation, cystic degeneration, size >10cm, irregular margins and heterogeneous enhancement all portend a poor prognosis. Enlarged feeding or draining vessels can predict relapse. Our patient’s case shows that it is important to have a high index of suspicion for diagnosis of GIST, particularly in the setting of atypical presentation.Figure 1.: Upper GI endoscopy image of the interior of the GIST cavity.

Gastric Diverticula: An Uncommon Finding

Gastric Diverticula (GD) are extremely uncommon. They define as an out pouching of the gastric wall to form a sac-like structure. They can be congenital or acquired and are mostly located on the posterior surface of the gastric fundus. GD is asymptomatic in general; however, they may present with discomfort or vague abdominal pain. Rarely, GD can be revealed by a complication, such as ulceration, perforation, or hemorrhage. Abdominal CT scan demonstrates a thin-walled, cystic lesion located in the posterior wall of the fundic region. It may sometimes contain air bubbles or air-fluid level. Communication with the gastric lumen is easily demonstrated by ingesting a water-soluble contrast. Differential diagnosis includes adrenal, pancreatic, and renal cysts, duplication cysts, and bowel diverticula.

Gastric Diverticulum: a Rare Cause of Dyspepsia

Objective: Diverticular disease of the stomach is uncommon and rarely suspected in all cases of upper gastro-intestinal pathology. The aim of this report is to demonstrate gastric diverticulum as an uncommon cause of upper gastrointestinal symptoms. The literature in Ghana shows no documented record; and we therefore seek to highlight gastric diverticulum as a possible differential diagnosis when evaluating patients with dyspepsia.Case Report and Intervention: We present a case of a 26 year old man who presented to the outpatient clinic with a 2-year history of recurrent epigastric pain and dyspepsia. This patient had previous upper gastrointestinal endoscopies which were normal. The recurrence of his symptoms necessitated a referral to Korle-Bu Teaching Hospital, a tertiary hospital, where the diagnosis of gastric diverticulum was confirmed at endoscopy. He was managed with proton pump inhibitors. Treatment is largely conservative, except incomplicated cases such as bleeding and perforation where surgery is indicated.Conclusion: Gastric diverticulum is rare in Ghana. A high index of suspicion is required to make a diagnosis especially in symptomatic patients with apparently normal gastric mucosa at endoscopy.

Diagnosis and treatment of sliding hiatal hernia and false gastric diverticulum in a British shorthair cat

AbstractA 7‐year 9‐month‐old, neutered, male British shorthair cat was referred for chronic regurgitation and vomiting. Previous symptomatic medical management did not improve these clinical signs. Survey radiographs and abdominal ultrasound revealed no significant abnormalities of the gastrointestinal tract. Exploratory laparotomy was performed to obtain gastrointestinal biopsies. Sliding hiatal hernia and an abnormal gastric outpouching at the fundus, measuring 15 × 15 × 15 mm, were identified. Surgical treatment of the hiatal hernia included phrenoplasty, oesophagopexy and left‐sided gastropexy. Additionally, the gastric outpouching was resected. Histopathologic examination of the excised fundic tissue revealed findings consistent with those indicative of a false gastric diverticulum. Postoperative examinations on Days 5 and 10 and telephone follow‐up on Days 30 and 120 revealed a marked reduction in clinical signs. The combination of surgical techniques—phrenoplasty, left‐sided gastropexy, oesophagopexy and gastric diverticulum resection—was found to effectively improve the cat's clinical signs.

Gastrointestinal Manifestation and Bipolar Disorder: About a Clinical Case

Introduction: The frequency of gastrointestinal manifestations in patients suffering with mood disorders, particularly bipolar disorders, pose specific physiopathological, etiological and therapeutic questions. We propose to address this issue through this clinical case. Clinical Case: We report here the case of a female patient 29-year-old, followed in psychiatry since 2014 for bipolar disorder type I and presenting an irritable colon syndrome, a biliary cyst, gastric diverticula and a chronic constipation. Discussion: Several hypotheses on the links between affectivity and gastrointestinal functioning are discussed in the light of the literature, explaining the role of the brain-gut axis as well as the involvement of the receptological profile of neuroleptics and also the role of the iatrogenicity of psychotropic drugs. Conclusion: There are definite links between affectivity and gastrointestinal manifestations. A better understanding of these links could enlighten us on the etiopathogeny of mood disorders, especially bipolar disorders, in order to guarantee a better management of psychiatric pathology as well as gastrointestinal manifestations.

Gastric diverticula in six cats: a case series (2011-2020).

Gastric diverticulum (GD) is a rare condition that is described adequately in humans but has not been reported in cats. This case series describes six cats with GD, including three that were published in a previous abstract. All cats presented for a variety of gastrointestinal disorders, including chronic vomiting, weight loss and anorexia, and underwent negative contrast radiography to diagnose GD. All but one cat underwent surgical resection of the GD via partial gastrectomy, while the remaining cat was euthanized. Resection of the GD was associated with reduction of reported clinical signs. Gastric diverticula have never been reported in the cat. Negative contrast radiography appears to be a superior imaging technique in the diagnosis of feline GD. In cats with a vague chronic history, including vomiting, anorexia and weight loss, GD should be considered among the differential diagnoses. Further study and more cases need to be identified to better assess clinical problems referable to GD in the absence of other comorbidities. Maine Coon cats with GD appear to be over-represented.

Incidental Finding of Phytobezoars within Gastric Diverticulum: Diagnosis and Treatment

Incidental Finding of Phytobezoars within Gastric Diverticulum: Diagnosis and Treatment

A Rare Cause of Dyspepsia: A Case Report of Gastric Diverticulum

A gastric diverticulum is an outpouching from the gastric mucosa. It is extremely rare. It is normally asymptomatic, but some may present with non-specific abdominal pain. A combination of upper gastrointestinal endoscopy and radiological contrast study such as oral barium study and computed tomography are needed to make a definite diagnosis and to rule out other associated pathology. Although treatment with medical therapy has been reported to be effective, the use of open and laparoscopic resection also yields a good outcome in the management of complicated gastric diverticulum. We present a case of symptomatic gastric diverticulum which has been successfully treated with medical therapy.

Gastric Diverticulum in Computed Tomography

Gastric diverticula (GD) are the outpouchings of the stomach wall. They are the least common diverticula of the gastrointestinal system (GIS). They are usually asymptomatic and are diagnosed accidentally by upper gastrointestinal contrast radiographic studies or endoscopy. Identification is important as they can cause serious complications such as bleeding or perforation. We herein present a case of asymptomatic congenital gastric diverticulum which was seen in computed tomography and proved with upper gastrointestinal endoscopy.