Laparoscopic Diverticulectomy Research Articles

Surgical treatment of a true diverticulum of the bladder in a patient with aplasia of the left kidney. Case report

A bladder diverticulum (BD) is a blindly terminating sac-like protrusion of the bladder wall with or without involvement of the muscular layer. BDs are categorized into true (congenital) and false (acquired), single and multiple. False diverticula are more common and develop in infravesical obstruction due to urethral stricture, prostate neoplasms, neurogenic disorders and other lower urinary tract diseases. Currently, there are no clear recommendations regarding the tactics of treatment of BD, so the choice of treatment method is based on the determination of the cause of BD, assessment of clinical manifestations and diagnostic results (localization, size, number, etc.), as well as the identification of concomitant anomalies and diseases of the upper urinary tract. The priority in the treatment of BD is surgical treatment. The article presents the observation of a patient with a developmental anomaly in the form of aplasia of the left kidney combined with a large congenital BD in the area of the missing mouth of the aplasic left ureter. The results of examination and treatment in the form of laparoscopic diverticulectomy are presented. A brief review of the literature on the problem of diverticulosis has been carried out.

325. SURGERY FOR EPIPHRENIC ESOPHAGEAL DIVERTICULUM, SHORT AND LONG TERM RESULTS

Abstract Background and Objectives We present our experience with laparoscopic surgery for epiphrenic oesophageal diverticulum. We wanted to assess our surgical results focusing on the patients’ quality of life. Short- and long-term results of surgical therapy were analysed. Methods 14 patients were examined with a symptomatic causing epiphrenic diverticulum. Patients underwent complex gastroenterological examinations before and after surgery (swallowing x-ray, oesophagogastroscopy, oesophageal manometry/pH monitoring). Surgery: laparoscopic transhiatal epiphrenic diverticulectomy with Heller cardiomyotomy and Dor anterior partial fundoplication were performed in 9 patients; laparoscopic diverticulectomy in 2 patients, laparoscopic Heller-Dor operation without diverticulectomy was 1 case (small (< 3cm) diverticulum) and laparoscopic diverticulectomy + Heller myotomy + Nissen fundoplication in 2 cases. Changes in quality of life with regard to symptoms related to oesophageal function were evaluated in our long-term studies (averaging 60 months, 10–138 months) by Eckardt-Zaninotto score. Results We had no intraoperative complication except one. In one case, a staple line leak developed (1/14 (7%), which was resolved with conservative therapy. Functional check-ups confirmed adequate oesophageal function in majority of the patients. The total symptom score for the patients was 6.3 points before surgery, and it decreased to 1.6 (P .001) after surgery, an average of 74% subjective improvement. During the follow-up period, proton pump inhibitor therapy was started in 4 patients to treat gastroesophageal reflux. In 3 cases, drug therapy was successful; in one case, Nissen antireflux surgery was performed. Conclusion Laparoscopic transhiatal diverticulectomy and Heller–Dor surgery are effective interventions with low morbidity. Patient quality of life significantly improves in the long term, but gastroesophageal reflux disease may occur. Key Words Epiphrenic oesophageal diverticulum, Laparoscopic transhiatal surgery, Long-term results

462. EPIPHRENIC DIVERTICULA. THERAPEUTIC ALTERNATIVES AND OUR EXPERIENCE

Abstract Background Epiphrenic diverticula account for less than 10% of esophageal diverticula and they are located in the last 10cm, in the right posterior quadrant. They are pseudodiverticula, lacking the muscular layer. Recent studies report that over 75% of these occur concomitantly with esophageal motility disorders, making it essential to evaluate them via manometry before deciding on intervention. Asymptomatic patients usually receive non-operative treatment. Indications for surgical treatment include increased diverticulum size, specific symptoms and suspicion of malignancy. Standard surgical treatment consists of laparoscopic approach with diverticulectomy, myotomy and Dor fundoplication. Methods We had 9 cases of esophageal epiphrenic diverticula that required surgical intervention in the last 16 years. In the vast majority of them, laparoscopic diverticulectomy was performed, along with myotomy and Dor fundoplication. Among them, there is a rare case of recurrence of a giant epiphrenic diverticulum in a 55-year-old patient treated with this approach. Due to the complexity of the case, partial esophagectomy and reconstruction with right-sided ascending coloplasty via posterior mediastinal route were decided as definitive treatment. Results The outcome was satisfactory in almost all patients, being the most frequent complications a suture line dehiscence and associated mediastinitis. Conclusion Esophageal diverticular pathology is uncommon, and its treatment is conservative in most cases. Over 75% of epiphrenic diverticula occur in the context of an underlying esophageal motor disorder. Indications for surgical intervention are the presence of symptoms, increased diverticulum size and suspicion of malignancy. The standard treatment consists in diverticulectomy, myotomy and fundoplication, but there are therapeutic alternatives that should be considered and individualized in each case. Symptoms disappearance after surgical treatment is nearly 90%. However, the procedure carries a morbidity and mortality rate of 20%, being the most common complication a suture line dehiscence, occurring in 33% of cases.

Three-dimensional laparoscopic approach to distal oesophageal diverticula: Single-centre experience.

Epiphrenic oesophageal diverticula are rare and often asymptomatic. When symptoms are present, minimally invasive diverticulectomy is considered the gold standard of treatment. While there is an agreement on the pre-operative assessment, no consensus is achieved when it comes to surgical technique. In the present study, we report our experience and propose a standardised approach to manage this rare oesophageal disorder. We prospectively analysed data of all consecutive patients who underwent three-dimensional (3D) laparoscopic distal oesophageal diverticulum resection during 2015-2020 at Upper gastrointestinal surgical department, St Thomas' Hospital, regarding pre-operative assessment, surgical technique, peri-and post-operative outcomes. Six patients were submitted to 3D laparoscopic diverticulectomy, five of which with additional anterior myotomy and fundoplication and one with additional hiatal hernia repair only. Three patients followed a specific diet in preparation for surgery. Median pre-operative Eckardt symptom score was five. Two patients had normal manometry. Median operative time was 180 min, median estimated blood loss was <100 ml, neither intraoperative complications nor conversions to open approach occurred. All patients reported a complete resolution of symptoms directly after surgery. Median follow-up was 66 months. Five patients have none or minimal residual symptoms. One had recurrence requiring a revision operation for intermittent dysphagia. 3D laparoscopic diverticulectomy offers a reasonable chance of treatment in patients with epiphrenic diverticula. Optimal selection of patients, optimisation for surgery, gaining the surgical experience of carrying out these techniques and impact on short- and long-term results are issues that still remain under debate.

S3439 Lemmel Syndrome Due to Periampullary Diverticular Food Impaction

Introduction: Lemmel Syndrome is a rare cause of mechanical biliary obstruction attributed to periampullary duodenal diverticula (PAD). It was first described in 1934 as obstructive jaundice in the absence of biliary stones or malignancy. The majority of PAD are asymptomatic, however, about 5% have symptomatic disease. We present a symptomatic case. Case Description/Methods: An 80-year-old woman with history of cholecystectomy, coronary artery disease, hypertension, and diabetes was transferred from a free-standing emergency room for acute pancreatitis. She had a one day history of postprandial epigastric pain with radiation to the back. Labs on presentation included lipase above 4000 U/L, BUN 27 mg/dL, AST 316 U/L, ALT 422 U/L, ALP 292 IU/L, total bilirubin 0.6 mg/dL. Abdominal ultrasound revealed 12mm common bile duct (CBD) with intrahepatic ductal dilatation. MRCP showed intra and extrahepatic biliary ductal dilatation with dilated pancreatic duct and a 3.6 cm fluid filled periampullary diverticulum. ERCP showed a large periampullary duodenal diverticulum with food impaction causing obstruction of the ampullary orifice which was removed with forceps. Cholangiogram revealed dilation of pancreatic, common bile, and intrahepatic ducts without any filling defects. Patient improved and was discharged home. (Figure) Discussion: The incidence of duodenal diverticula is approximately 17% with PAD being the most common type. PADs are pseudo-diverticula most commonly found in the second part of the duodenum and they pose a cannulation challenge during ERCP with an increased risk of complications. PAD in the setting of biliary obstruction is known as Lemmel Syndrome. It can cause biliary obstruction by sphincter of Oddi dysfunction, direct obstruction, or via external compression by fluid or material-filled PAD. In our case, there was biliary compression due to a food-filled PAD. Cross sectional imaging is critical for diagnosis, however, ERCP is the gold standard. Several therapeutic modalities including endoscopic extraction of entrapped food or stones, extracorporeal shock wave lithotripsy, and laparoscopic diverticulectomy have been used. Our case required endoscopic extraction of diverticular food debris and adds to the limited published cases to date. Lemmel Syndrome requires a high index of suspicion when a PAD is found in the setting of biliary obstruction.Figure 1.: A. MRCP image showing a large periampullary diverticulum packed with debris. B. ERCP image of food impacted inside periampullary diverticulum. C. MRCP image demonstrating a dilated common bile duct in absence of choledocholithiasis.

598. EPIPHRENIC DIVERTICULUM CAUSING GASTROESOPHAGEAL JUNCTION OUTFLOW OBSTRUCTION (EGJOO)

Abstract Oesophageal diverticulum is a rare cause of dysphagia. They are classified based on location- Zenker’s diverticulum distal to the cricopharyngeus; epiphrenic diverticulum above the lower oesophageal sphincter (LES)- or pathophysiology – traction vs pulsion. The prevalence of epiphrenic pulsion diverticulum ranges from 0.2% to 0.8%. We present a case of epiphrenic diverticulum and its management. A 68 year old lady presents with dysphagia to solids and liquids, belching, food regurgitation, and acid brash for 10 years. She had no loss of weight, but experienced daily regurgitation and occasional retrosternal pain. Physical examination was unremarkable. We worked her up with further investigations and scans. A CT abdomen reported a hiatus hernia and mural thickening of distal oesophagus with upstream oesophageal distension. A oesophagogastroduodenoscopy showed residual food in oesophagus. The lower oesophagus was dilated and the LES appeared tight with no masses. There was no hiatus hernia on endoscopy. Barium swallow revealed the lower oesophageal dilatation to be an epiphrenic diverticulum. Manometry studies showed oesophago-gastric junction outflow obstruction. She underwent laparoscopic excision of esophageal diverticulum, cardiomyotomy and anterior partial fundoplication. The video serves to highlight the surgical key steps. She was discharged on post-operative day 3 without complications and barium swallow pre/post op as shown. Oesophageal diverticulum, although rare, remains a differential for dysphagia. For epiphrenic diverticulum, it is important to understand that this is a pulsion diverticulum, with an accompanying gastro-oesophageal outflow obstruction. In addition to surgical management with a laparoscopic diverticulectomy, a cardiomyotomy and partial fundoplication to treat underlying motility disorder is important. This case study and video serves to highlight the condition and present minimally invasive surgical management.

Лапароскопічна одночасна дивертикулоектомія сечового міхура та уретероцистостомія за Lich-Gregoir

To show the advantages of laparoscopic technique as a method for the best visualization and simplification of the method of surgical intervention in diverticulum of bladder, and the technique of antireflux surgery for vesicoureteral reflux of different degrees in children. Purpose - to share experiences and demonstrate the technique of making the antireflux mechanism, and to show life hacks to make the bladder diverticulectomy easier. Materials and methods. In 2016-2021 there were 23 patients with VUR of different degrees. Two of them had a bladder diverticulum. In one case - ectopia of the ureter into the diverticulum. In another case the ingress of the ureter was anatomically correct. Results. Steps of operation. The patient’s position is on the back with a roller under the lumbar region. The optical port is installed transumbilically. Two working ports are installed: on the middle line between the navel and the «spina illiaca anterior» of pelvic. Pneumoperitoneum - 8-10 mm Hg. Technique. At the same time with laparoscopy, cystoscopy to better visualize of edge of the diverticulum. After that, the diverticulum was excised and the walls of the bladder were sutured. In the case of ectopia of the ureter into the diverticulum made ureterocystomy, followed by antireflux protection by Lich-Gregoir. And in another case only antireflux protection was made. Specificity of antireflux protection technique. Marking and forming of the submucosal tunnel does by a hook and / or scissors. Previously do the traction of the bladder over the ureter in the direction of the anterior abdominal wall. The next step is to fix the bladder with three holders, which are output. This makes it easier to dissect the layers of the bladder. The ureter was placement into the sub mucous tunnel. And muscular tunica and walls were sutured of material 4/0. Specific of drainage. When antireflux protection perform - the stent was not installed into the ureter. At ureterocystoneostomy - the stent was placements for a period of 30 days. Drainage of abdominal was performed in all cases. An urinary catheter was additionally placements in the bladder for 3 days. There were no intraoperative or postoperative complications. Duration of surgery up to 180 minutes. Conclusions. Laparoscopic ureterocystoneostomy is, in our opinion, more convenient for the surgeon and more gentle for the patient. Allows you to significantly reduce the number of postoperative complications. This laparoscopic diverticulectomy of the bladder has been demonstrated, showing a significant advantage in the convenience of visualization of the diverticulum and easier removal of the diverticulum of the bladder. The study was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of parents and children was obtained for the study. No conflict of interests was declared by the authors. Key words: diverticulum of bladder, laparoscopy, ureterocystostomy.

ENDOSCOPIC STENTING IN THE TREATMENT OF RECURRENT EPIPHRENIC DIVERTICULUM AFTER LAPAROSCOPIC DIVERTICULECTOMY. CLINICAL CASE REPORT

Epiphrenic diverticulum, also known as a pulsion diverticulum, is a rare type of esophageal diverticulum occurring in the distal 10 centimeters of the esophagus. They are most commonly 4-10 cm above the gastric cardia representing 10% of all esophageal diverticula. Laparoscopic diverticulectomy has become the treatment of choice. This clinical case study is dedicated to minimally invasive treatment of recurrent epiphrenic diverticulum after laparoscopic diverticulectomy. A 74-year-old male patient was admitted to the hospital with complaints of dysphagia, regurgitation and halitosis. The examination revealed a 5 cm epiphrenic diverticulum with sings of inflammation. Laparoscopic transchiatal diverticulectomy, the Dor (anterior) fundoplication, cruroraphia and mediastinal drainage were performed. The patient was discharged on the 11-th postoperative day. The patient exhibited dysphagia relapse during a 3-month follow-up. Taking into account the previous surgical treatment and the habitus endoscopic esophageal stenting was chosen as the technique of choice for management. Under intravenous anesthesia a partially covered metal self-expandable stent 10 cm x 1.8 cm was inserted into the distal esophagus. Next day control fluoroscopy showed stable stent position and no evidence of leakage. The water-soluble contrast agent reached stomach freely. The patient was discharged on the 2nd post-operative day. Within 4 months after having a stent placed, the patient feels well and oral feeding is satisfactory. In terms of literature search we have not come across any reference to the post-epiphrenic diverticulectomy recurrence treatment, so the management was chosen individually based on the comorbid status of the patient. The installation of a partially covered metal self-expandable stent allowed to promptly eliminate dysphagia and design features enabled to achieve stent stable position. A partially covered metal self-expandable stent can be considered effective in the post-epiphrenic diverticulectomy recurrence treatment.

A Case of Epiphrenic Esophageal Diverticulum Resected by Laparoscopic Diverticulectomy

A Case of Epiphrenic Esophageal Diverticulum Resected by Laparoscopic Diverticulectomy

The Feasibility, Technique, and Medium-Term Follow-Up of Laparoscopic Transvesical Diverticulectomy

Background: To present our experience and results with the transvesical laparoscopic diverticulectomy, developed by Pansadoro et al. [BJU Int. 2009;103(3):412–24], as treatment of symptomatic bladder diverticula, with a medium-term follow-up. Methods: Between June 2010 and July 2018, we successfully operated 15 patients (13 male/2 female), aged 32–85 years (mean age 61 years) in 2 centers in Austria, using the aforementioned technique. Results: The median operative time was 297 min (range 83–488 min), and the blood loss was minimal. The median diameter of the diverticula was 94 mm (range 40–110 mm). The transurethral catheter was removed in most patients on day 7 (range 1–26 days), and cystography was performed before catheter removal. Patients were discharged on the ninth postoperative day (range 4–18 days). One case had a Clavien-Dindo grade IIIb complication (ureter injury), and 2 cases had a grade IIIa complication (nephrostomy drainage). After a median follow-up of 19 months, no recurrences were observed. Conclusion: The laparoscopic, transvesical diverticulectomy is a feasible and valuable procedure with good outcomes. To avoid complications, the ureter needs to be spared meticulously.

Perforation of a Meckel’s diverticulum secondary to chronic NSAID use: case report and review of the literature

Meckel´s diverticulum is an abnormality in the development of the gastrointestinal system, its origin and clinical significance was first described by Johan Friedrich Meckel in 1809. It is a remnant of the omphalomesenteric duct which is usually observed following the rule of 2’s, located 2 feet proximal to the ileocecal valve, before 2 years of age in approximately 2% of the population, and is twice as common in male population. It is considered a true diverticulum because it presents all the histopathological layers of the bowel; 6% of the cases present with heterotopic tissue, mainly pancreatic, gastric, colonic or jejunal. We present the case of a 37-year-old patient who presented with acute onset epigastric pain which migrated to the right iliac fossa, he had a history of chronic non-steroidal anti-inflammatory drugs (NSAIDs) usage for articular pain. He underwent abdominal contrast tomography (CT) scan with double iodine contrast enhancement, which revealed the presence of a perforated Meckel´s diverticulum in the antimesenteric portion of the terminal ileum. The patient underwent laparoscopic diverticulectomy with no complications and was discharged 72 hours after the procedure. Histopathological confirmation of a perforated meckel’s diverticulum with heterotopic gastric mucosa confirmed the clinical suspicion of perforation secondary to chronic NSAIDs usage.

Laparoscopic transhiatal surgery for an epiphrenic esophageal diverticulum derived from a jackhammer esophagus: a case report

BackgroundAn esophageal diverticulum is rare and is frequently associated with esophageal motility disorders. Jackhammer esophagus is also rare, is characterized by esophageal hypercontraction, and comprises 4.1% of esophageal motility disorders. Here, we report a case of a patient successfully treated by laparoscopic transhiatal surgery for an epiphrenic esophageal diverticulum derived from a jackhammer esophagus diagnosed with high-resolution manometry (HRM).Case presentationThe patient was a 78-year-old man who presented to the hospital with dysphagia. A diverticulum was detected in the lower part of his esophagus by upper gastrointestinal endoscopy. HRM was performed to investigate esophageal motility disorders. His integrated relaxation pressure was normal at 25.9 (< 26) mmHg, but his distal contractile integral (DCI) was very high at 21,464 (1500–13,000) mmHg s cm. Esophageal peristalsis was preserved. Therefore, the patient was diagnosed as having an epiphrenic esophageal diverticulum derived from a jackhammer esophagus for which laparoscopic transhiatal diverticulectomy and Heller-Dor procedure were performed. The postoperative course was uneventful. His symptoms improved, and the level of DCI also returned to a normal level of 3867 mmHg s cm at 2 months after the operation.ConclusionLaparoscopic transhiatal diverticulectomy and esophagomyotomy can be useful procedures for an epiphrenic esophageal diverticulum derived from a jackhammer esophagus due to their lower invasiveness.

Robot-assisted laparoscopic diverticulectomy with ureteral reimplantation

The objective is to describe our experience with robot-assisted laparoscopic diverticulectomy with extravesical ureteral reimplantation in a pediatric patient. A 7-year-old male presented with a symptomatic urinary tract infection secondary to Staphylococcus epidermidis. The patient was found to have a large congenital paraureteral bladder diverticulum on work-up. His options were discussed and he proceeded with robotic diverticulectomy. Intraoperatively, the diverticulum was found to obscure the left ureteral orifice, which necessitated synchronous dismembered extravesical ureteral reimplantation. Robot-assisted laparoscopic diverticulectomy with extravesical ureteral reimplantation was performed. The procedure time was 283min, and estimated blood loss was 3mL. The patient was discharged home on post-operative day 1. He was last seen in clinic six months after surgery and was doing well without any recurrent urinary tract infections. This video demonstrates a robotic approach for the treatment of complex congenital bladder diverticula. Robotic surgery offers the benefits of good visualization in the pelvis, minimal blood loss, and quick convalescence. Key portions of the diverticulectomy and ureteral reimplantation are clearly illustrated in this video, which can help other surgeons adopt this technique.

Laparoscopic diverticulectomy or laparoscopic-assisted resection of symptomatic Meckel diverticulum in children? A systematic review.

Recent reports have recommended laparoscopic diverticulectomy for symptomatic Meckel diverticulum (MD) rather than laparoscopic-assisted extracorporeal resection. This technique may risk leaving residual ectopic mucosa leading to complications. This systematic review attempts to quantify the relative risks of both approaches. A systematic review was conducted according to PRISMA guidelines. Articles were eligible for inclusion if they reported data on the laparoscopic management of symptomatic MD in children. Eleven reports were identified, all of which were institutional retrospective studies. Pooled outcome data on 248 children showed no statistically significant difference in complications between laparoscopic diverticulectomy (n = 133) and laparoscopic-assisted segmental resection (n = 115) (3% vs. 6.1%, p = 0.39). One patient from the diverticulectomy group re-presented with recurrent bleeding necessitating segmental small bowel resection. Conclusions are limited by the number of patients and variable follow up. Short, wide MD with a height:base ratio of < 2; diverticula with thickening or ischemia at the base and those complicated by volvulus or small bowel obstruction are probably best treated by laparoscopic-assisted extracorporeal resection. For other symptomatic diverticula laparoscopic diverticulectomy is a reasonable approachwith a less than 1% risk of leaving residual ectopic gastric mucosa.

Transurethral enucleation of the prostate combined with laparoscopic bladder diverticulectomy

Objective We present a one-session procedure for treating bladder diverticula combined with benign prostatic hyperplasia (BPH). Material and methods Between January 2015 and April 2019, transurethral plasmakinetic enucleation of the prostate (TUEP) followed by laparoscopic bladder diverticulectomy (LD) were performed in 12 patients at our institution, in four of them combined with bladder stone(s) and in one patient combined with diverticular tumor. Clinical data were retrospectively collected. Results The mean size of the prostate was 137.3 ± 96.3 (65.5–403.3) ml. The mean maximal diameter of the diverticulum was 8.0 ± 2.7 (3.2–12.0) cm. The mean total operation time was 214.2 ± 69.0 (120–300) min, and the mean enucleation time was 23.2 ± 6.4 (12–35) min. The mean intraoperative blood loss was 52.1 ± 14.9 (30–80) ml. The average pre- and post-operative maximum flow rate was 5.1 ± 1.4 (2.4–8.5) ml/s and 12.8 ± 2.3 (9.6–17.1) ml/s. Except for urinary infection in one patient, no other severe peri- or postoperative complications were observed. Conclusions TUEP accompanied by LD in one session provides an effective and minimally invasive surgical treatment for bladder diverticula combined with BPH, with or without bladder stones, and permits reasonable operation time and rapid discharge.

Symptomatic and Incidental Meckel’s Diverticulum in Children: Our Experience and Lesson

Introduction: The management of incidentally detected Meckel’s Diverticulum (MD) at laparotomy or laparoscopy has been debatable. In asymptomatic cases, the surgical management is associated with complication of around 1% but the complication rates are variable in other conditions like peritonitis. Aim: To assess the management and outcome of incidentally diagnosed MD. Materials and Methods: A retrospective study was conducted from January 2012 to December 2019 using the case records of the patient. The study included all the patients who were diagnosed with cases of MD in the Department. The patients were divided into two groups: Symptomatic Group and Incidental Group. The case records of all the patients were reviewed and data were collected for the demographic details, mode of presentation, the basis of diagnosis, treatment, outcome and follow-up. Results: Total 132 patients were included in the study, 74 (56.06%) subjects were in symptomatic group and 58 (43.9%) were in incidental group. The mean age of symptomatic patients was 3.1±1.1 years and the incidental group was 6.5±2.4 years. It was significantly less in the symptomatic group (p≤0.001). All the patients in the symptomatic group were managed by laparotomy with diverticulectomy in 8 (10.8%), Wedge resection in 10 (13.5%) cases, segmental bowel resection in 44 (59.4%) and ileostomy in 12 (16.2%) cases. In the incidental group 9 (15.5%) patients underwent laparoscopic diverticulectomy and in rest 49 (66.2%) cases, only the primary procedure was performed. Six (10.3%) patients of incidental group without any intervention presented with complication in follow-up. Conclusion: The laparoscopic diverticulectomy of MD should be performed in incidentally diagnosed cases of younger age group.

Laparoscopic diverticulectomy for a gangrenous Meckel's diverticulitis mimicking acute appendicitis in an adult

Johann Friedrich Meckel was the first to feature the anatomy and embryology of a diverticulum in 1809, as an incomplete obliteration of the omphalomesenteric duct, and named this as Meckel's diverticulum. Since then, lots of facts have been gained about its presentations and treatments. When a surgeon encounters a Meckel's diverticulitis with a normal base instead of an inflamed appendix in a patient with acute pain in the right iliac fossa, diverticulectomy should suffice. We present a patient with clinical features of acute appendicitis but was found to have torsion and gangrene of a Meckels diverticulum. This was successfully managed by laparoscopic diverticulectomy with a hand-sewn technique. Laparoscopy has utility in the treatment of complicated Meckel's diverticulitis.

Acute small bowel obstruction caused by phytobezoar Meckel diverticula

Introduction. Meckel diverticulum-is a residue of not completely reduced yolk duct. Among the occurring complications of Meckel’s cuticle in the adult population, acute intestinal obstruction prevails. In this case, the most common intussusception and inversion of the intestines. The occurrence of small bowel obstruction due to phytobesoar in the Meckel diverticulum is a rare condition and has been described in the literature in isolated cases. Materials and methods. The patient of 29 years entered the surgical Department with complaints of abdominal pain of a permanent nature, violation of the discharge of stool and gases, vomiting up to 4 times. Sick for about 2 days. Fluoroscopy of the abdomen showed multiple arches with small bowel fluid levels, single bowl kloybera. The man was operated on urgently with a diagnosis of acute mechanical small bowel obstruction. Results. During the operation, Meckel’s phytobezoar diverticula was detected, which caused acute small bowel obstruction, for which the fragmentation of the bezoar was performed with its relegation to the cecum. The postoperative period proceeded without complications, the patient was discharged on the 10th day after surgery. After 6 weeks, the patient underwent laparoscopic diverticulectomy as planned. Discharged for 5 days. Conclusion. A clinical case of treatment of a patient with phytobezoar Meckel diverticulum complicated by acute mechanical small bowel obstruction is presented. The use of delayed diverticulectomy can reduce the risk of anastomosis failure in acute intestinal obstruction, and if proper diet is observed, it reduces the risk of recurrent intestinal obstruction before re-planned hospitalization.

Safety and efficacy of submucosal tunneling endoscopic septum division for epiphrenic diverticula.

Symptomatic epiphrenic diverticula are mostly treated with laparoscopic diverticulectomy. Our study aimed to demonstrate the safety and efficacy of submucosal tunneling endoscopic septum division (STESD) for treatment of symptomatic epiphrenic diverticula. Data from patients with epiphrenic diverticula who had undergone STESD were retrospectively reviewed. The parameters analyzed were the modified Eckardt score, total procedure time, length of hospital stay (LOS), number of clips used, adverse events, and patient satisfaction. A total of eight patients (5 men; mean [standard deviation (SD)] age 66.25 [7.17] years) were enrolled in our study. The mean (SD) size of epiphrenic diverticula was 3.68 (1.59) cm. The mean (SD) procedure time was 52.87 (22.47) minutes, with a median number of six clips being applied. The modified Eckardt score significantly decreased post-procedure (P < 0.001). The mean (SD) LOS was 5.87 (0.83) days. No adverse events or symptom recurrences were reported. STESD is a safe and effective technique to be performed in the submucosal tunnel for the management of patients with epiphrenic diverticula.

Meckel's diverticulum perforation by a wooden toothpick in a child: A case report

Abstract Perforation of Meckel's diverticulum (MD) by ingested foreign body (FB) is an extremely uncommon cause of acute abdomen in children. We report on a 13-year-old boy who presented with right iliac fossa pain associated with anorexia, tenderness, guarding and rebound tenderness. Abdominal ultrasound showed findings of acute appendicitis. However, laparoscopy revealed a wooden toothpick perforating MD and a hyperemic appendix. The FB was removed and laparoscopic diverticulectomy and appendectomy performed. Perforation of MD by a FB is a diagnostic challenge and it should be included in the differential diagnosis of acute abdomen in children.