Gastric Diverticulum Research Articles

S3064 A Pill-Filled Gastric Diverticulum: An Unusual Cause of Acute Abdominal Pain

INTRODUCTION: Gastric diverticula (GD) are rare with an incidence of 0.01–2.6%. While often asymptomatic and incidentally discovered, they may result in abdominal discomfort. We present a case of a pill-filled GD resulting in severe epigastric pain. CASE DESCRIPTION/METHODS: A 60-year-old male presented to the ED secondary to sudden onset of severe epigastric pain preceded by 2 days of moderate epigastric pain and nausea. He denied vomiting or change in bowel habits. His medical history was significant for coronary artery disease and ulcerative colitis in remission on mesalamine. He was hemodynamically stable. Initial labs were unrevealing. Liver function tests and serum lipase were within normal limits. EKG was normal sinus rhythm without ischemic changes, and troponins were negative. He was initiated on proton pump inhibitor (PPI) therapy, analgesia and hyoscyamine without relief. Ultrasound of the right upper quadrant was nonrevealing. CT abdomen revealed a posterior gastric diverticulum containing medication tablets. Due to refractory pain, the patient underwent EGD which confirmed a posterior gastric diverticulum, approximately 2–3 cm in size containing pills and undigested food. In total, 8 pills resembling mesalamine were removed from the diverticulum. Following EGD, the patient reported complete resolution of his abdominal discomfort. Diverticular distention due to pill impaction was suspected to be the etiology of his symptoms. He was discharged home in good health on a PPI with plans for outpatient surgical evaluation. DISCUSSION: GD may result in upper abdominal discomfort (18–30%), dyspepsia, nausea, and halitosis. Pain associated with GD is thought to be secondary to diverticular distention. Thus, diverticula with a wide neck are less symptomatic due to reduced trapping of undigested food. Diverticular retention of food may result in increased gastric acid secretion and resultant diverticulitis. Inflammation may lead to ulceration and, in rare cases, hemorrhage or perforation. Management of GD is determined by size and symptom burden. Diverticula smaller than 4 cm may be managed conservatively with antacid therapy. However, surgical intervention is pursued if associated with refractory symptoms, hemorrhage, perforation or size greater than 4 cm. Both laparoscopic and endoscopic resection have proven to be safe and efficacious. Given its rarity, a high index of suspicion is required for prompt diagnosis. Therefore, we encourage clinician awareness.Figure 1.: Coronal abdominal CT revealing a posterior gastric diverticulum filled with medication tablets.Figure 2.: EGD confirming a posterior gastric diverticulum with the neck measuring approximately 2 cm. Found to filled with 8 pills and undigested food.

An Unusual Presentation of Gastric Diverticulum – a Rare Form of Gastrointestinal Tract Diverticulum

In this report, we present two cases of gastric diverticulum (GD) documented by upper gastrointestinal contrast radiographic studies and computed tomography (CT). The first one, a 51-year-old woman, has a typical presentation, with the GD occurring in the posterior wall of the fundus (figure 1). The second one, a 72-year-old woman, has a sliding diaphragmatic hernia. In this patient, the gastric fundus, which also has a diverticulum, is herniated, being located inside the thorax (figure 2 and figure 3). Both patients discovered the presence of gastric diverticula incidentally during diagnostic testing for other reasons.

Gastric Diverticulum Presenting as Hematemesis: A Case Report Detailing an Uncommon Presentation of an Already Rare Entity.

IntroductionGastric diverticula (GD) are uncommon. Most are asymptomatic and diagnosed incidentally. Symptoms range from reflux and epigastric discomfort to life-threatening bleeding and perforation. We describe a case of symptomatic GD presenting as hematemesis requiring surgical treatment.Case ReportA 57-year-old female presented to the emergency department (ED) with one day of epigastric pain and hematemesis. Hemoglobin was found to be stable, but blood urea nitrogen was elevated. Imaging revealed a fundal GD. Esophagogastroduodenoscopy did not show other etiology of hematemesis. The patient underwent partial gastric resection for GD removal and did well without further symptoms on follow-up.ConclusionAlthough rare, GD needs to be included on a differential diagnosis when evaluating gastrointestinal symptoms in the ED. Patients may present with an array of complaints but can potentially develop serious complications. Providers should be familiar with the diagnostic options and treatment regimens available to better care for patients presenting with GD.

Gastric Diverticulum as an Incidental Finding in a 16-year-old Patient

Gastric Diverticulum as an Incidental Finding in a 16-year-old Patient

Incidental Gastric Diverticulum in an Elderly Male with Chronic Dyspepsia

Incidental Gastric Diverticulum in an Elderly Male with Chronic Dyspepsia

Incidental Gastric Diverticulum in an Elderly Male with Chronic Dyspepsia

Incidental Gastric Diverticulum in an Elderly Male with Chronic Dyspepsia

Incidental Gastric Diverticulum in an Elderly Male with Chronic Dyspepsia

Incidental Gastric Diverticulum in an Elderly Male with Chronic Dyspepsia

Incidental Gastric Diverticulum in an Elderly Male with Chronic Dyspepsia

Incidental Gastric Diverticulum in an Elderly Male with Chronic Dyspepsia

Prepyloric Diverticulum in a Nigerian: Case Report of a Rare Finding

Diverticulae are uncommonly encountered in the stomach. They can be congenital or acquired- the latter variety being the less frequent of the two. This article details one such rare case from Lagos, Nigeria and discusses certain aspects of its clinical and endoscopic presentation. We present a 59-year old with a background history of non-steroidal anti-inflammatory drugs abuse presented with hematemesis and melena and was in hemorrhagic shock. After stabilization, the gastroscopy findings were of a gastric diverticulum (GD) in the anterior prepyloric wall. There was a Forrest IIb ulcer in the GD’s wall with surrounding erythema and edema. The patient was successfully managed medically and conservatively and with good long term results.

Diagnosis and surgical treatment of symptomic stomach diverticulum

Gastric diverticulum is a rather rare disease. This lesion is diagnosed in about 0.01% of cases during contrast-enhanced X-ray examination and in 0.04-0.11% of patients undergoing endoscopic examination. Symptomatic diverticulum is complicated by diverticulitis, bleeding, perforation and malignant transformation. Therefore, surgical resection is indicated. We report surgical treatment of a patient with diverticulum of the cardiac part of the stomach. Endoscopic and X-ray examination was valuable to establish the correct diagnosis. Laparoscopic approach minimized surgical trauma and reduced surgery time.

Gastric Diverticulum: as a Cause of Unspecific Abdominal Pain

Gastric diverticulum is the rarest type of diverticular disease of the gastrointestinal tract, ranging from 0.02 to 0.11% in different series. We report the case of a 53-year-old male patient who presented with upper abdominal pain that was associated with gastric diverticulum and cholelithiazis. There was no specific health history or family history of disease, trauma, operation and drug use. He described having epigastric abdominal pain for a few days. An endoscopic evaluation revealed a round-shaped gastric diverticulum structure. Additional imaging studies such as abdominal ultrasonography and computerized tomography diagnosed two separate pathologies as follows: multiple millimetric cholelithiazis and 16 mm in diameter, located near the esophagogastric junction, gastric diverticulum. This patient was considered as mild symptomatic cholelithiazis and asymptomatic, small gastric diverticulum. Symptomatic anti-acid treatment was prescribed.

1911 Acquired Double Pylorus: The Road Less Traveled

INTRODUCTION: A double pylorus channel can be congenital or acquired. Acquired double pylorus is thought to be the result of a gastric or duodenal ulcer forming a fistula between the prepyloric antrum and the duodenal bulb. Although it is a rare endoscopic finding, seen in only 0.001%–0.4% of upper gastrointestinal endoscopies1, when acquired, it signifies peptic ulcer disease (PUD) which needs risk factor modification and treatment. CASE DESCRIPTION/METHODS: A 50-year-old man with alcohol use disorder, newly diagnosed alcoholic cirrhosis and recent NSAID use presented with confusion, melena and dark emesis. His physical exam was notable for hypotension (BP 86/55 mmHg), somnolence, confusion and positive asterixis. Laboratory values were remarkable for hemoglobin of 5 g/dL, BUN of 48 mmol/L, platelets of 271 × 109/L and INR of 2. Management included fluid resuscitation, blood transfusion, proton pump inhibitor and octreotide drip. Once hemodynamically stabilized, an upper endoscopy was performed revealing blood in the gastric body, two antral ulcers with visible vessels, but no endoscopic stigmata of liver disease. Adjacent to the pylorus, a slit-like channel connecting the prepyloric antrum to the duodenal bulb was noted and traversed with the endoscope. Helicobacter pylori work up revealed a positive serum antibody. Patient did well post-procedure and received Helicobacter pylori eradication treatment and counseling on alcohol cessation and NSAID avoidance. DISCUSSION: In contrast to congenital double pylorus which is an incidental finding, patients with acquired double pylorus often present with symptoms of PUD. In this case, likely culprits included NSAIDs and Helicobacter pylori. It should be distinguished from other similar appearing endoscopic findings such as gastric diverticulum, as risk factors for PUD need to be investigated in patients with an acquired double pylorus. While treatment with acid suppression and Helicobacter pylori eradication should be pursued, the fistula tract often persists despite treatment2. Endoscopic recognition and familiarity are key to ensure appropriate risk modification, treatment and prevention of endoscopic complications with side-viewing scopes.

2018 Occam’s Diverticula: Multiple Causes of Significant Lower GI Bleeding in a Young Man

INTRODUCTION: Meckel’s Diverticulum (MD) is the most common congenital malformation of the gastrointestinal tract. MD is difficult to diagnose as it presents with intermittent symptoms or none at all. Lower gastrointestinal bleeding (LGIB) is the most common presentation. The diagnosis is made even more difficult when there are other plausible causes of bleeding on endoscopy. We present a case of severe LGIB in a young man with right sided diverticulosis found to have symptomatic MD after a prolonged work-up. CASE DESCRIPTION/METHODS: A healthy 23-year-old male presented with several episodes of bright red blood per rectum and crampy abdominal pain relieved by defecation. He denied taking any NSAIDs. He was hemodynamically stable with mild, lower abdominal tenderness. During admission, his hemoglobin decreased from 14.4 to 8.6 and he became hypotensive, pale and diaphoretic requiring two units of packed red blood cells. CT of abdomen and pelvis was unremarkable. EGD did not reveal a cause of bleeding. Colonoscopy showed scattered, small-mouthed diverticula in the ascending colon with no active bleeding and he was discharged with a presumptive diagnosis of diverticular bleeding. Video capsule endoscopy (VCE) performed for a second admission for hematochezia found blood clots throughout the distal small bowel without active bleeding. After much delay, a 99mTc pertechnate scan showed MD. He underwent surgery and had an ectopic gastric mucosa-containing diverticulum resected. He sustained no additional bleeding following surgery. DISCUSSION: Gastrointestinal bleeding is a major cause for hospitalization in adults. Less than 5% of cases are attributed to small-bowel sources. Diagnosis is more difficult when there are more common explanations for bleeding available. Diverticula located in the right colon are more likely to bleed despite being less common than left-sided ones, making them a plausible explanation for our patient’s symptoms. Even with the advent of non-invasive techniques to visualize the small bowel, diagnosing a small bowel bleed can prove to be a challenging feat. Diagnosis is affected by the features associated with a MD to include active bleeding, inversion or presence of heterotopic mucosa. Sensitivities for 99mTc pertechnate scan, CT and VCE are low at approximately 60, 48 and 8%, respectively, leaving much room for undiagnosed MD. High index of suspicion and multiple imaging modalities are required for diagnosis of MD, especially when more common explanations are present.

Divertículo gástrico congénito como hallazgo casual en paciente de 16 años

Divertículo gástrico congénito como hallazgo casual en paciente de 16 años

Incidental Gastric Fundus Diverticulum during Laparoscopic Sleeve Gastrectomy

Incidental Gastric Fundus Diverticulum during Laparoscopic Sleeve Gastrectomy

Abdominal surgery as a possible cause of gastric diverticula: Single center one year experience

Abdominal surgery as a possible cause of gastric diverticula: Single center one year experience

Gastric diverticulum of the antrum: An unusual endoscopic finding.

Key Clinical MessageGastric diverticula are rare and may sometimes cause diagnostic confusion. Most cases are asymptomatic and diagnosed incidentally. However, sometimes they can cause a variety of clinical manifestations and may be complicated by bleeding, perforation, or malignancy. Therefore, clinicians should be aware of this unusual finding and the available management options.

Case Report: Gastric diverticulum: an uncommon endoscopic finding in a case of halitosis

A gastric diverticulum is an outpouching of the stomach or gastric wall. It is an uncommon anatomical abnormality and can present with a variety of symptoms. Here, we present an interesting case of a gastric diverticulum along with halitosis, which was diagnosed on esophagogastroduodenoscopy (EGD) and was managed successfully with conservative treatment, and we review the relevant literature. Surgery is required in case of failed medical management and severe complications.Key words: Gastric diverticulum; Halitosis; esophagogastroduodenoscopy; conservative; Surgery

Gastric diverticulum causing gastric outlet obstruction in the setting of duodenal atresia

Abstract Duodenal obstruction due to duodenal atresia occurs in 1 in 10,000 live births and is the most common type of intestinal obstruction in neonates [1–3]. Gastric outlet obstruction in the newborn period from causes other than hypertrophic pyloric stenosis is very uncommon [3]. Potential etiologies include gastric volvulus, antral web, and duplication cysts. Gastric diverticula in the infant is even more rare, with only a few case reports published, and only one describes a gastric diverticulum in the presence of a duodenal atresia [4–8]. In this report, we describe the first case of a gastric outlet obstruction due to a gastric diverticulum in the presence of duodenal atresia.

The Double Pylorus

88 year female with medical history of hypertension, type 2 diabetes mellitus, hyperlipidemia, osteoarthritis, gastroesophageal reflux disease and a vague history of peptic ulcer disease (PUD) presented to emergency department with 2 episodes of black stool and increasing fatigue over the past 3 days. She also reported using ibuprofen regularly for osteoarthritic related symptoms. Physical exam and basic laboratory investigations were also normal with the exception of hemoglobin, which was 7g/dL. Esophagogastroduodenoscopy (EGD) demonstrated a large non-bleeding ulcer (15mm in largest dimension) in the antrum. Notably, there was also a second luminal opening between the antrum and duodenal bulb adjacent to the ulcer consistent with a double pylorus (see Fig. 1 and Fig. 2). Double pylorus is a rare endoscopic finding, found in 0.001% to 0.4% of EGD. It is characterized by two openings between the distal stomach and the duodenal bulb. It can be classified as congenital or acquired based on etiology. Congenital double pylorus is usually found in association with other congenital anomalies like heterotopic pancreatic tissue, pancreatic divisum or gastric duplication. The acquired double pylorus (ADP) is usually associated with PUD and results from a prepyloric ulcer or duodenal bulb ulcer eroding into the duodenum or stomach creating a fistulous opening. Additionally, the use of NSAIDS, corticosteroids and persistent H. pylori infection can affect the healing of ulcers and can lead to ADP. Diagnosis is made by endoscopy or occasionally by radiography with the lesser curvature of stomach being the most common location of these fistulous openings. Double pylorus should be differentiated from a gastric diverticulum during endoscopy and can also be mistaken with a large mucosal fold, tumor or polyp during evaluation with upper gastrointestinal series. Treatment of double pylorus consists of promotion of mucosal healing with proton pump inhibitor and less commonly H2 blockers, avoidance of NSAIDS/corticosteroids, and treatment of H. pylori infection. The majority of fistulas do not close (or may only partially close), however endoscopic division of the bridging tissue with a sphinterotome should be considered for patients presenting with gastric outlet obstruction. Surgical intervention is an option for patients with obstruction refractory to endoscopic treatment or the presence of other complications such as perforation or refractory bleeding.Figure: Second luminal opening between the antrum and duodenal bulb adjacent to the ulcer consistent with a double pylorus.Figure: Second luminal opening between the antrum and duodenal bulb adjacent to the ulcer consistent with a double pylorus.